Herniation of an enlarged middle cerebral artery through a temporal bone defect in association with an arteriovenous malformation

Abstract We present a previously undescribed variant of the middle cerebral artery (MCA) protruding through a defect in the temporal bone, associated with a large arteriovenous malformation (AVM). The patient, a 59-year-old male, presented with a large right frontoparietal AVM with feeding aneurysms...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2012-11, Vol.19 (11), p.1591-1593
Main Authors: Raley, Darryl Alan, Davidson, Andrew Stewart, Morgan, Michael Kerin
Format: Article
Language:English
Subjects:
Aneurysm, Ruptured - surgery
Cerebral Angiography
Craniotomy
Endovascular Procedures
Hernia - pathology
Herniorrhaphy
Humans
Intracranial Aneurysm - surgery
Intracranial arteriovenous malformations
Intracranial Arteriovenous Malformations - complications
Intracranial Arteriovenous Malformations - pathology
Intracranial Arteriovenous Malformations - surgery
Intraoperative complications
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Middle Aged
Middle cerebral artery
Middle Cerebral Artery - pathology
Middle Cerebral Artery - surgery
Neurology
Postoperative Complications
Temporal Bone - abnormalities
Temporal Bone - pathology
Temporal Bone - surgery
Tomography, X-Ray Computed
Vascular system injuries
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Summary:Abstract We present a previously undescribed variant of the middle cerebral artery (MCA) protruding through a defect in the temporal bone, associated with a large arteriovenous malformation (AVM). The patient, a 59-year-old male, presented with a large right frontoparietal AVM with feeding aneurysms and a recent haemorrhage. Preoperative imaging demonstrated a tortuous right MCA feeder abutting the anterosuperior temporal bone in the region of the pterion. An associated temporal bone defect was visible. The patient underwent a pterional craniotomy for surgical clipping of aneurysms associated with the AVM. On reflection of the temporalis muscle, the MCA branch was transected as it coursed through a defect in the temporal bone. This patient demonstrates that the MCA may deviate from its usual anatomy and herniate through a defect in the skull. Because a pterional craniotomy is such a common surgical approach, knowledge and anticipation of such anatomic variants are essential to avoid catastrophic vascular injury during surgery.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2012.03.020