Left Superficial Temporal Artery Research Articles

Superficial temporal artery aneurysm misdiagnosed in a patient with long-term migraine headache treatment: a case report

BackgroundSuperficial temporal artery aneurysm is a rare vascular abnormality without specific clinical symptoms. In this case report, we present the case of a patient with superficial temporal artery aneurysm who was diagnosed with migraine headache at first.Case presentationA 60-year-old Iranian man with a previous history of headaches, who did not respond properly to the treatments following the initial diagnosis of migraine, presented with a painless lump in the left temporal region, and he was diagnosed with superficial temporal artery aneurysm via Doppler ultrasound. Finally, surgical removal of the left superficial temporal artery aneurysm was performed.ConclusionsThis case shows the importance of vascular causes in the approach to headache etiologies, especially when the headache is prolonged without proper responses to treatment. Computed tomography angiography and magnetic resonance angiography are appropriate diagnostic methods for aneurysm detection that should be considered in future studies.

Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome presenting as recurrent aseptic peritonitis in a patient receiving peritoneal dialysis: a case report

BackgroundVacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is caused by mutations in the ubiquitin-activating enzyme1 (UBA1) gene and characterised by an overlap between autoinflammatory and haematologic disorders.Case presentationWe reported a case of a 67-year-Japanese man receiving peritoneal dialysis (PD) who had recurrent aseptic peritonitis caused by the VEXAS syndrome. He presented with unexplained fevers, headache, abdominal pain, conjunctival hyperaemia, ocular pain, auricular pain, arthralgia, and inflammatory skin lesions. Laboratory investigations showed high serum C-reactive protein concentration and increased cell count in PD effluent. He was treated with antibiotics for PD-related peritonitis, but this was unsuccessful. Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography images demonstrated intense FDG uptake in his left superficial temporal artery, nasal septum, and bilateral auricles. The working diagnosis was giant cell arteritis, and he was treated with oral prednisolone (PSL) 15 mg daily with good response. However, he was unable to taper the dose to less than 10 mg daily because his symptoms flared up. Since Tocilizumab was initiated, he could taper PSL dose to 2 mg daily. Sanger sequencing of his peripheral blood sample showed a mutation of the UBA1 gene (c.122 T > C; p.Met41Thr). We made a final diagnosis of VEXAS syndrome. He suffered from flare of VEXAS syndrome at PSL of 1 mg daily with his cloudy PD effluent. PSL dose of 11 mg daily relieved the symptom within a few days.ConclusionsIt is crucial to recognise aseptic peritonitis as one of the symptoms of VEXAS syndrome and pay attention to the systemic findings in the patients.

Less invasive bonnet bypass with subcutaneous tunneling method for common carotid artery occlusion - A technical note.

Common carotid artery occlusion (CCAO) sometimes requires vascular reconstruction. Ipsilateral superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is unsuitable due to insufficient blood flow to the external carotid artery. The bonnet bypass, one treatment option for CCAO, requires a long coronal incision and bone groove to prevent malposition and collapse of an interposition graft. However, this long incision might lead to skin complications and reduced collateral blood flow. A 60-year-old man who experienced recurrent ischemic stroke presented with the right internal carotid artery occlusion and left CCAO. The left STA was unavailable; however, both branches of his right STA were well-developed. Minimizing skin invasion was a priority because the patient had diabetes mellitus. We performed a right STA parietal branch - right MCA anastomosis, followed by a right STA frontal branch - left radial artery graft (RAG) - left MCA bonnet bypass using small intermittent skin incisions. We drilled a bone groove extending across the entire length of the interposition graft through the small intermittent skin incisions. Furthermore, we applied a right STA-RAG end-to-side anastomosis instead of an endto-end anastomosis to preserve collateral skin anastomosis. Postoperatively, the bypass remained patent, and the patient was discharged without complications. The bonnet bypass is a potential treatment for CCAO, but the procedure is invasive. Our modified bonnet bypass method enables less invasive management, preventing collapse and malposition of the interposition graft and minimizing skin complications.

Surgical Trapping of a Cavernous Carotid Aneurysm Causing Carotid Cavernous Fistula After Flow Diverter Placement: Technical Note and Literature Review

Flow diverter (FD) treatment is a promising therapeutic strategy for intracranial aneurysms such as cavernous carotid aneurysms (CCAs). Direct cavernous carotid fistula (CCF) caused by delayed rupture of FD-treated CCAs has been reported, and endovascular therapy has been used in the literature. Surgical treatment is warranted for patients who have failed or ineligible for endovascular treatment. However, no studies have evaluated surgical treatment to date. Here, this paper presents the first case of direct CCF due to delayed rupture of an FD-treated CCA managed with surgical internal carotid artery (ICA) trapping with bypass revascularization, in which the intracranial ICA with FD placement was successfully occluded with aneurysm clips. A 63-year-old man with a diagnosis of large symptomatic left CCA underwent FD treatment. The FD was deployed from the supraclinoid segment of the ICA distal to the ophthalmic artery to the petrous segment of the ICA. Since angiography 7 months after the FD placement showed progressive direct CCF, left superficial temporal artery-middle cerebral artery bypass followed by ICA trapping was performed. The intracranial ICA proximal to the ophthalmic artery where the FD was placed was successfully occluded using two aneurysm clips. The postoperative course was uneventful. Follow-up angiography 8 months after the surgery confirmed complete obliteration of the direct CCF and CCA. The intracranial artery in which the FD was deployed was successfully occluded with two aneurysm clips. ICA trapping can be a feasible and useful therapeutic option to treat direct CCF caused by FD-treated CCAs.

Percutaneous Superficial Temporal Artery Access Facilitating Carotid Artery Stenting Performed From Distal Radial Artery.

The purpose of the study is to describe carotid artery stenting (CAS) via distal transradial access (dTRA) facilitated by additional superficial temporal artery (STA) access, in a patient with complex aortic arch vessel anatomy. A 72-year-old woman with a prior history of complex cervical surgery and radiotherapy due to laryngeal malignancy, presented with a symptomatic 90% stenosis of the left internal carotid artery (ICA). Due to high cervical lesion, the patient was rejected from carotid endarterectomy. Angiography demonstrated 90% stenosis of the left ICA and a type III aortic arch. After failure of left common carotid artery (CCA) cannulation with appropriate catheter support via dTRA and transfemoral approaches, CAS was attempted a second time. After percutaneous ultrasound guided access to right dTRA and left STA, a 0.035 inch guidewire introduced to the left CCA from the contralateral dTRA was snared and externalized via left STA to improve wire support for guiding advancement. Thereafter, the left ICA lesion was successfully stented with a 7×30 mm self-expanding stent via right dTRA. All vessels involved were patent at 6-month follow-up. The STA may be a promising adjunctive access site to increase transradial catheter support for CAS or neurointerventional procedures in the anterior circulation. Transradial cerebrovascular interventions have been gaining popularity, however, unstable catheter access to distal cerebrovascular structures limits its widespread use. Guidewire externalization technique via additional STA access may improve transradial catheter stabilty and increase procedural success with possibly low access stie complication rate.

Abstract Number ‐ 216: Limb‐Shaking Transient Ischemic Attack in the Setting of Moyamoya Disease

Introduction Moyamoya disease (MMD) is a cerebrovascular disorder characterized by progressive narrowing of the large intracranial arteries, primarily the internal carotid artery (ICA) and its branches, with secondary development of prominent small‐vessel collaterals. Limb shaking is a rare manifestation of transient ischemic attack (TIA) that is characterized by brief, irregular, involuntary jerking of the arms or legs and momentary disorientation without complete loss of consciousness. It is mainly associated with high grade carotid stenosis. In rare cases, limb‐shaking TIA can occur in the setting of MMD. Methods The patient was identified in routine clinical practice. Results A woman in her 50s presented with a six‐year history of progressive weakness below the neck when standing and initiating movement. These episodes were followed by violent shaking of her arms and legs that lasted several seconds to minutes. She reported transient confusion after the events, but no seizure activity was seen on multiple EEGs, and anti‐epileptic drugs (AEDs) failed to alleviate her symptoms. Further neurological workup included a MR angiogram of the brain that was suggestive of MMD. Catheter angiography confirmed bilateral occlusion of the M1 segments of the middle cerebral arteries (MCAs) and the A1 segment of the left anterior cerebral artery (ACA). There was neovascularization in the same territories with significant collateral flow from the posterior circulation. She was diagnosed with bilateral limb‐shaking TIA in the setting of MMD. She recently underwent two revascularization procedures, a left superficial temporal artery (STA) to middle cerebral artery (MCA) bypass and a right sided encephaloduroarteriosynangiosis (EDAS). Conclusions Limb‐shaking TIA is predominantly associated with severe atherosclerotic extracranial carotid artery stenosis. In rare cases, the limb‐shaking episodes are caused by cerebral hypoperfusion secondary to severe stenosis of the ICAs, and their branches, in the setting of moyamoya disease. Treatment of limb‐shaking TIA to prevent further brain ischemia includes adjustment of fluid intake, careful blood pressure management to avoid episodes of relative brain hypoperfusion, and revascularization procedures. Revascularization is also the most effective method of treating MMD and patients will often experience improvement of their symptoms within one year. Early recognition of limb‐shaking TIA in MMD is critical to avoid unnecessary and potentially harmful treatments (e.g. AEDs), provide patients with accurate explanations of their symptoms, and ensure timely administration of the appropriate treatments.

True superficial temporal artery aneurysm: A case after extracranial-intracranial bypass surgery and a systematic review.

Nontraumatic true superficial temporal artery aneurysm (STAA) is rare, and its characteristics and pathogenesis are unclear. We report a case of STAA and performed a systematic review of PubMed, Scopus, and Web of Science using the keyword "superficial temporal artery aneurysm" to include studies on STAA reported through July 2022. We excluded studies on STAA associated with trauma, arterial dissection, infection, or vasculitis. A 63-year-old woman who underwent left superficial temporal artery (STA)-middle cerebral artery bypass surgery 8 years previously was diagnosed with an aneurysm located at the left STA. The blood flow volume estimated by ultrasonography was higher in the left STA than in the contralateral counterpart (114 mL/min vs. 32 mL/min). She underwent clipping surgery to prevent aneurysmal rupture without sequela. The lesion was diagnosed as a true aneurysm by histology. The systematic review identified 63 cases (including the present case) of nontraumatic true STAA. The median age of the patients was 57 (interquartile range [IQR]: 41-70) years. Most (90.5%) cases were detected as a palpable mass. Aneurysmal rupture occurred in only 1 (1.6%) case, despite the large size of aneurysms (median size: 13 [IQR: 8-20] mm) and the high frequency (33.3%) of aneurysmal growth during observation. Most (93.7%) patients underwent surgical resection of STAA without sequela. Our findings suggest that the pathogenesis of true STAA is promoted by hemodynamic stress. The systematic review clarified patients' and aneurysmal characteristics and treatment outcomes, providing further insight into the pathogenesis of nontraumatic true STAA.

Salvage Superficial Temporal Artery to Middle Cerebral Artery Direct Bypass Using an Interposition Graft for Failed Encephaloduroarteriosynangiosis in Moyamoya Disease

Moyamoya disease may present with either hemorrhagic or ischemic strokes. Surgical bypass has previously demonstrated superiority when compared to natural history and medical treatment alone. The best bypass option (direct vs. indirect), however, remains controversial in regard to adult ischemic symptomatic moyamoya disease. Multiple studies have demonstrated clinical as well as angiographic effectiveness of direct bypass in adult hemorrhagic moyamoya disease. In particular, there are limited data regarding strategies in the setting of failed indirect bypass with recurrent hemorrhagic strokes. Here, we describe a salvage procedure. We describe a case of a 52-year-old man who presented with hemorrhagic moyamoya disease and failed previous bilateral encephaloduroarteriosynangiosis (EDAS) procedures at an outside institution. On a 3-year follow-up diagnostic cerebral angiogram, no synangiosis was noted on the right side and only minimal synangiosis was present on the left. The left hemisphere was significant for a left parietal hypoperfusion state. We performed a salvage left proximal superficial temporal artery to distal parietal M4 middle cerebral artery bypass using the descending branch of the lateral circumflex artery as an interposition graft with preservation of the existing EDAS sites. The patient underwent the procedure successfully and recovered well with resolution of headaches and no further strokes or hemorrhages on the 1-year follow-up magnetic resonance imaging of the brain. This case presents the use of a salvage direct bypass technique for recurrent symptomatic hemorrhagic moyamoya disease after failed EDAS. The strategy, approach, and technical nuances of this unique case have implications for revascularization options.

TRAUMATIC TRUE ANEURYSM OF SUPERFICIAL TEMPORAL ARTERY: A RARE CASE REPORT

True Superficial temporal artery aneurysm is commonly painful or painless and pulsating mass. It is rarely results from blunt traumatic injury to the side of head. Only small number of these cases has been reported in the previous literature. We describe diagnosis and management of a 34 year old male who had history of physical assault hit by bottle (glass), resulted in developing a true large aneurysm of left superficial temporal artery (STA). Simple selective ligation and excision of STA aneurysm was performed. Patient has been discharged without any post operative complication.

Post traumatic pseudoaneurysm of the superficial temporal artery in child

Aneurysms of the superficial temporal artery (STA) were first described in 1740, yet it remains a very uncommon post traumatic entity usually associated with sporting activities in young men or recurrent falls in older patients. A 10-year-old boy presented 4 weeks after blunt trauma to the head with a slowly enlarging left temporoparietal swelling. Clinical examination revealed a pulsatile and expansive mass of 4 cm with discoloration of the overlying skin. The ultrasound revealed a pseudoaneurysm of the left anterior superficial temporal artery. Excision was performed under general anesthesia. The mass was exposed, and the proximal and distal branches were ligated. The lesion was entirely removed and hemostasis was easily obtained. Histological examination showed a lesion consistent with pseudoaneurysm. The diagnosis of aneurysms or pseudoaneurysms of the STA can usually be made based on a thorough patient history and physical examination. They are easily treated with few long-term consequences. However, left untreated theses lesions can rupture leading to significant hemorrhage or cause compression of neighboring vessels and nerves. Treatment involves external compression, thrombin injection or surgical resection.

Giant cell arteritis with cervical radiculopathy mimicking polymyalgia rheumatica and elderly-onset rheumatoid arthritis: a case report

BackgroundGiant cell arteritis has a wide variety of clinical symptoms, one of them being cervical radiculopathy, which mainly involves the C5 nerve root. If the patient does not develop typical clinical symptoms of giant cell arteritis but has C5 radiculopathy, it may be misdiagnosed as polymyalgia rheumatica or elderly-onset rheumatoid arthritis due to old age, high serum inflammatory markers, and difficulty in raising both upper limbs.Case presentationA 72-year-old Japanese man with a month-long history of dyspnea on exertion and with difficulty in raising both upper limbs was referred to our hospital because of elevated serum C-reactive protein (12.62 mg/dL). He had no typical symptoms of giant cell arteritis such as headache, jaw claudication, visual loss, and fever. The patient tested negative for rheumatoid factor and anti-cyclic citrullinated peptide antibody, and matrix metalloproteinase-3 was within the normal range (54.3 ng/mL). Musculoskeletal ultrasound examination showed absence of tenosynovitis, bursitis, and synovitis, and the patient did not meet the classification criteria of polymyalgia rheumatica or rheumatoid arthritis; hence, those two diseases were unlikely. A precise neurological examination suggested bilateral C5 and C6 anterior radiculopathy and left C4 radiculopathy. Since cervical magnetic resonance imaging showed no mechanical causality, cervical radiculopathy of unknown origin was suggested. Fluorodeoxyglucose positron emission tomography/computed tomography revealed increased fluorodeoxyglucose lineal uptake along the vessel walls, including temporal arteries, vertebral arteries, and axillary arteries. Results of the biopsy of the left superficial temporal artery were compatible with giant cell arteritis. He was successfully treated with 30 mg of prednisolone, and both upper limbs could be elevated.ConclusionsIf the patient was misdiagnosed with polymyalgia rheumatica or elderly-onset rheumatoid arthritis based on only clinical symptoms and laboratory data, his symptoms might not improve due to insufficient steroid dose and vascular complications may occur later. Although rare, peripheral neuropathy in giant cell arteritis may include cervical radiculopathy. The musculoskeletal ultrasound and precise neurological examination were the turning points for the diagnosis of this case, and making a careful diagnosis using these methods was important.

Analysis of Development Mechanism of Giant Cell Arteritis in Nude Mouse Model through Color Duplex Sonography and Computerized Tomography Nanocontrast Agent.

To explore the application value of color duplex sonography and enhanced computerized tomography (CT) inspection based on a nanocontrast agent in diagnosis and pathogenesis in giant cell arteritis (GCA), the GCA nude mouse model was constructed. In this study, 40 healthy male BalB/c nude mice aged 6-8 weeks were randomly divided into a control group (no model) and an experimental group (model), with 20 mice in each group, and the temporal artery tissue of GCA patients diagnosed as positive by temporal artery biopsy was implanted into nude mice to construct a GCA nude mouse model. Abdominal aortic biopsy and immunohistochemistry were used to verify the success of the GCA nude mouse model. All nude mice were subjected to color duplex sonography and enhanced CT examination based on a nanocontrast agent. At the same time, the basic indicators such as body weight, temperature, white blood cell (WBC), lymphocytes (LYM), hemoglobin (HGB), and platelet (PLT) were measured, and the protein expression levels of interleukin-6 (IL-6) and signal transducer and activator of transcription 3 (STAT3) were detected by immunohistochemistry. The results showed that the temporal artery wall of the nude mice in the experimental group thickened and the lumen was significantly narrowed, indicating that the cell arteritis model of nude mice was successfully constructed; ultrasound examination showed that the right superficial temporal artery vascular cavity narrowed, the blood flow signal changed like a filling defect around the periphery, and there was a low echo halo. CT examination showed that the left superficial temporal artery narrowed, and the inner diameter of the narrow segment of blood vessels changed like a bead. The body weight of nude mice in the experimental group decreased significantly after the modeling was completed (P < 0.05); after modeling, the body temperature of the nude mice in the experimental group increased significantly (P < 0.05); LYM and HGB values of nude mice in the experimental group were significantly lower than those in the control group (P < 0.05); the content of IL-6, STAT3, IL-6, and STAT3 proteins in the arterial tissue of nude mice in the experimental group was lower than that of the control group (P < 0.05), indicating that color duplex sonography and CT contrast agent technology can be used in the diagnosis and development mechanism research of GC.

Posttraumatic pseudoaneurysm involving the superficial temporal artery in a pediatric patient

Superior temporal artery pseudoaneurysms were first described by Thomas Bartholin in 1740, and since then approximately 400 cases have been reported in the literature. It is estimated that of aneurysms that are surgically repaired, traumatic aneurysms, pseudoaneurysms, and arteriovenous (AV) fistulas of the superficial temporal artery (STA) account for 0.5%–2.0%. Of these, only a few reported are in the pediatric population. An otherwise healthy 16-year-old male presented to UNM Pediatric Surgery Clinic with a small temporal mass in January 2020. He had previously been punched in the side of the head in August 2019 and noticed the mass after the bruising and swelling in the area had subsided. The mass was then determined to most likely be a posttraumatic pseudoaneurysm of the temporal artery, based on exam showing a 1 cm soft, mobile, pulsatile mass. A CT angiogram of the head and neck confirmed. Observation, IR intervention, and surgical removal were discussed with the patient and his mother in clinic, and they opted for surgical removal. In February 2020, he underwent an excision of left superficial temporal artery pseudoaneurysm under general anesthesia. Intraoperatively, it was noted that a part of the superficial temporal vein was densely adherent to the pseudoaneurysm, and was small inferior to the pseudoaneurysm, and engorged superiorly, concerning for a possible fistula formation. This was not confirmed intraoperatively, but a portion of the left superficial temporal vein had to be excised as there was no clear plane between the pseudoaneurysm and the vein. Pathology results did not demonstrate a fistula formation, but did confirm a pseudoaneurysm of the STA.

A 78-year-old female with severe tongue pain: benefit of modern ultrasound

BackgroundGiant cell arteritis (GCA) is the most common form of systemic vasculitis in persons aged 50 years and older. Medium and large vessels, like the temporal and axillary arteries, are commonly affected. Typical symptoms are headache, scalp tenderness, jaw claudication and ophthalmological symptoms as loss of visual field, diplopia or amaurosis due to optic nerve ischemia. Tongue pain due to vasculitic affection of the deep lingual artery can occur and has so far not been visualized and followed up by modern ultrasound.Case presentationWe report the case of a 78-year-old woman with typical symptoms of GCA, such as scalp tenderness, jaw claudication and loss of visual field, as well as severe tongue pain. Broad vasculitic affection of the extracranial arteries, vasculitis of the central retinal artery and the deep lingual artery could be visualized by ultrasound. Further did we observe a relevant decrease of intima-media thickness (IMT) values of all arteries assessed by ultrasound during follow-up. Especially the left common superficial temporal artery showed a relevant decrease of IMT from 0.49 mm at time of diagnosis to 0.23 mm on 6-months follow-up. This is the first GCA case described in literature, in which vasculitis of the central retinal artery and the lingual artery could be visualized at diagnosis and during follow-up using high-resolution ultrasound.ConclusionHigh-resolution ultrasound can be a useful diagnostic imaging modality in diagnosis and follow-up of GCA, even in small arteries like the lingual artery or central retinal artery. Ultrasound of the central retinal artery could be an important imaging tool in identifying suspected vasculitic affection of the central retinal artery.

MOYAMOYA DISEASE: A STORY OF MULTIPLE STROKES

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Moyamoya disease (MMD) is a specific cerebrovascular disease first described in 1957 by Japanese surgeons, characterized by stenosis or occlusion of the terminal portions of bilateral internal carotid arteries (ICA) with development of fragile small vessel collateral blood vessels. It may cause ischemic attacks or cerebral infarction, more frequent in children than adults. Incidence peaks in two different age groups: children who are approximately 5 years of age and adults in their mid 40's. Initial presentation is that of TIA or cerebral ischemia/hemorrhage. CASE PRESENTATION: 46-year-old female with history of hypertension initially presented with right sided tingling and numbness, CT head was negative, CTA head and neck significant for left ICA stenosis, she received tPA. Underwent full neurology work up including MRI no acute stroke or acute bleeding, MRA head and neck showed >80% narrowing of left ICA, etiology at that time was unknown. Followed by neurology clinic with imaging every 6 months; MRI Brain/MRA two years after initial presentation significant for left ICA supraclinoid occlusion and right supraclinoid moderate stenosis, left hemisphere supply via leptomeningeal collaterals from posterior cerebral artery (PCA) and anterior cerebral artery (ACA) consistent with MoyaMoya Disease. She subsequently had left superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. Remained asymptomatic for two more years until gradual onset of forgetfulness and memory loss. Repeat imaging at that time demonstrated evolving ischemia of frontal region and high-grade stenosis of bilateral internal carotid arteries, she underwent an additional intracranial bypass. DISCUSSION: Moyamoya disease is a chronic, occlusive cerebrovascular disease involving bilateral stenosis of ICA or occlusion of the terminal portions of MCA and ACA. There are four types of MMD: ischemic, hemorrhagic, seizures, or "other;” hemorrhagic being more common in adults. Initial presentation consists of symptoms of TIA or stroke like symptoms including severe headaches, unilateral weakness, or memory changes. On angiography, characteristic stenosis or occlusion of bilateral terminal portion of ICAs as well as the moyamoya vessels are seen at the base of the brain. Cases with milder symptoms can be medically managed, while more severe symptomatic cases are treated with revascularization such as STA-MCA anastomosis. However, these procedures do not prevent progression of disease and patients may require multiple procedures to prevent ischemic episodes. CONCLUSIONS: Moyamoya disease is a chronic, occlusive cerebrovascular disease involving bilateral ICA, initial symptoms are those of TIA or stroke. Milder cases can be managed medically but more severe cases require surgical intervention, however, this does not slow down progression of disease. Reference #1: Burke, G., Burke, A., Sherma, A., Hurley, M., Batjer, H., Bendok, B (2009). Moyamoya Disease: A Summary. Journal of Neurosurgery. https://doi.org/10.3171/2009.1.FOCUS08310 Reference #2: Fukui M, Kono S, Sueishi K, Ikezaki K. Moyamoya disease. Neuropathology. 2000;20 Suppl:S61-S64. https://doi.org/10.1046/j.1440-1789.2000.00300.x Reference #3: Scott, M., Smith, E. (2009). Moyamoya Disease and Moyamoya Syndrome. The New England Journal of Medicine. 2009; 360: 1226-37. http://moya-moya.org/wp-content/uploads/2011/05/moya-moya.pdf DISCLOSURES: no disclosure on file for Victor Montalvan; No relevant relationships by Brandon Rogers, source=Web Response No relevant relationships by Jasmine Sekhon, source=Web Response

A false traumatic aneurysm of the superficial temporal artery: case report and literature review

Introduction: Pseudoaneurysms or false aneurysms originating from superficial temporal artery (STA) are rare and often seen as facial swellings. These forms of aneurysms often involve the intimal and media layers of the arterial wall. So far only single cases have been reported at various locations across the world since 1644. We report another unique case of traumatic STA pseudoaneurysms. Case Presentation: We present a 51-year-old man with a 1-year history of a pulsatile mass on the left forehead. He suffered a blunt trauma at the temporal region of the left forehead a year prior. Computed tomography angiography confirmed left STA pseudoaneurysms. The lesion was total resected via surgery. We reconstructed parent artery after resecting the pseudoaneurysm. The patient recovered well with an overall good cosmetic look. Conclusions: It is very necessary to report the occurrences of STA pseudoaneurysms because the swelling could be mistaken for other lesions leading to inappropriate treatment especially in facilities with no modern radiologic modalities.

Successful endovascular treatment of extracranial arteriovenous malformation of a head: a case report

Introduction. Arteriovenous malformations (AVM) of the head represent the rare lesions that have a congenital, traumatic or post-infectious nature. In the last decade, endovascular methods have become the most prevalent in the treatment of AVM. Staged embolization is performed to achieve maximum effect and minimize the complications.Case report. A 30-year-old female patient is presented with complaints of enlarged vessels in the frontal and parietal regions. CT-angiography scan and cerebral angiography showed extracranial AVM of the fronto-parietal regions with afferent vascular supply from the right and left superficial temporal and ophtalmic arteries with significant expansion of the afferent arteries and the presence of varix dilatation of the draining veins. Two-stage endovascular embolization of AVM was performed. The first stage was embolization of the afferent vessels from the left superficial temporal artery system with exclusion of 60–65% AVM volume. Three months later, the second stage was performed with embolization of the afferent vessels from the right superficial temporal artery system and the exclusion of 75–80% of the residual volume of AVM. The non-adhesive composition SQUIDR12 (Emboflu, Switzerland) and glue composition PHILR25% (Microvention, USA) were used. A good aesthetic effect was achieved. Postoperative complications were not observed. There was no recurrence during the observation within a year.Summary. The staging and the use of various liquid embolization agents in the treatment of AVM of the head allow to achieve a good aesthetic outcome and prevent complications associated with facial soft tissue necrosis.

Bonnet Bypass for Left Superficial Temporal Artery Bifurcation to Right Middle Cerebral Artery: 2-Dimensional Operative Video.

A bonnet bypass is a long interposition graft bypass used for extracranial to intracranial revascularization, which is useful in patients who do not have a suitable ipsilateral donor or in whom the ipsilateral donor must be sacrificed. This interposition graft is commonly the radial artery or saphenous vein. The only practical difference in this technique for revascularization is that an interposition graft must pass through the subgaleal space to the contralateral scalp to allow for reimplantation at the desired contralateral point of anastomosis. This patient underwent a bonnet bypass for revascularization of the middle cerebral artery (MCA) perfusion territory utilizing the contralateral superficial temporal artery (STA). A saphenous vein was used as the interposition graft, which was anastomosed to an M2 segment bifurcation. The graft was then temporarily occluded and passed within a calvarial trough to the contralateral frontoparietal region. The graft was then anastomosed to the contralateral STA at a bifurcation to accommodate the graft size mismatch. The patient tolerated the bypass procedure well and demonstrated bypass patency on postoperative angiographic imaging. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Occipital artery-anterior cerebral artery bypass with posterior auricular artery-middle cerebral artery bypass for stenosis of the internal carotid artery bifurcation

Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass, and STA-anterior cerebral artery (ACA) bypass, are options for direct revascularisation of anterior circulation. However, some patients don't have a suitable STA to use as a donor, so an alternative procedure must be performed. A 59-year-old, right-handed man presented with dysphasia and right-sided hemiparesis due to a transient ischaemic attack. Imaging studies revealed severe stenosis of the left internal carotid artery bifurcation. Iodoamphetamine single photon emission computed tomography demonstrated reduced cerebrovascular reserve capacity in the left hemisphere. The patient was started on antiplatelet therapy, but the ischaemic attacks persisted after one month. Thus, revascularisation of the ACA and MCA territories was considered. Digital subtraction angiography revealed prominence in the left occipital artery (OA) and posterior auricular artery (PAA), while the left STA was hypoplastic, terminating at the squamous suture level. Therefore, anastomoses were performed between both the OA and ACA and the PAA and MCA. Revascularisation was successful, and the ischaemic attacks disappeared. OA-ACA bypass, together with PAA-MCA bypass, may be effective for wide cerebral revascularisation when the STA is not available.

Treatment of Multiple Dural Arteriovenous Fistulas Associated with Visual Disturbances in a Chronic Schizophrenia Patient: A Case Report

A 51-year-old woman presented with visual disturbances that had persisted for approximately one year. She had been taking psychiatric medication for schizophrenia. Brain magnetic resonance imaging showed engorged vessels in both hemispheres, and a delay in the mean transit time and time to peak was observed on perfusion images. The initial transfemoral cerebral angiography showed multiple dural arteriovenous fistulas (AVFs) with cortical venous reflux and venous ectasia. Both middle meningeal arteries (MMAs), superficial temporal arteries (STAs), and occipital arteries (OAs) were feeding the fistulas, and the superior sagittal sinus was the draining vein. Owing to the presence of multiple lesions and feeder arteries, a staged treatment was planned. We first performed the Onyx embolization of the left MMA, followed by the surgical ligation of the left STA, with subsequent embolization of the left OA. Finally, the venous ectasia was clipped. Importantly, after treatment, the patient’s schizophrenia-like symptoms improved. The patient could be originally misdiagnosed with schizophrenia. This case shows that staged and active treatment should be considered in case of multiple dural AVFs for improvement of symptoms. Key words: Arteriovenous fistula; Intracranial arteriovenous malformations; Schizophrenia