A spontaneous true aneurysm of the superficial temporal artery treated by surgical resection

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

Background

Nontraumatic true superficial temporal artery aneurysm (STAA) is rare, and its characteristics and pathogenesis are unclear.

Methods

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.

Results

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.

Conclusion

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.

The oldest patient in literature of spontaneous true giant superficial temporal artery aneurysm

Background

Superficial temporal artery (STA) aneurysms are very rare compared to vascular aneurysms of other regions. They are divided into two as true and pseudo. Pseudoaneurysm were much more common and often depend on an etiological factor but spontaneous true aneurysms are extremely uncommon and the etiologic causes are not clear yet.

Case presentation

We present a 91-year-old female patient who consulted to us with swelling in front of the ear; there was no history of previous surgery or any trauma. The patient had a pulsatile mass in the preauricular region, which started 4 years ago and growed faster for the last 2 months.

Conclusion

There was a mass consistent with a saccular type aneurysm whose continuity was observed with the temporal artery in imaging studies. The mass was excised under general anesthesia. The patient whose pathological examination was a true STA aneurysm was discussed in the light of the literature.

True Aneurysm of Temporal Superficial Artery Arise Spontaneously. Case Report

Aneurysms of the temporal superficial artery (TSA) are very rare clinical entity. From 1861 to the present day, is described less than 200 cases. The most common cause of these aneurysms is so called blunt head trauma but there are described many cases of iatrogenic aneurysms, very rarely, aneurysms arise spontaneously. We report a case of 17-yearold patient with spontaneously formatting aneurysm of TSA. Three months prior to admission, he noticed the existence of tumefaction localized frontotemporal on the right side. MSCT angiography of blood vessels of the scalp showed an aneurysm on the frontal branch of TSA diameter of 15 mm. The aneurysm was resected with uneventful postoperative course. PH findings pointed to a true aneurysm. Treatment protocol for the aneurysms of the TSA include clinical monitoring, compression of the aneurysm, the injection of thrombin, endovascular treatment and surgical resection. Surgical resection has proven to be a safe and effective treatment modality and still is the method of choice.

Congenital True Aneurysm of the Right Superficial Temporal Artery

Introduction

Superficial temporal artery aneurysms (STAAs) occur in 1% of arterial aneurysms; mostly (95%) are pseudoaneurysms following trauma; true aneurysms are rare (5%); forty-five cases are reported.

Aim

To report a rare case of a congenital STAAA.

Case Report

A67-year-old patient recalled the existence of a true-histologically evidenced- aneurysm of the right superficial temporal artery since his childhood denying any head injury; it was resected through a horizontal skin incisure. Brain arteries' magnetic imaging was negative.

Conclusion

Spontaneous or congenital STAAs have to be removed respecting forehead lines. Intracranial vasculature must be investigated.

Superficial temporal artery pseudoaneurysm presenting as a growing, pulsatile, and tender mass

BACKGROUND

Superficial temporal artery (STA) pseudoaneurysms have been reported in the literature since the mid of seventeenth century from Bartholin, however, there is an increasing number of cases, suggesting a diversity of etiological factors. Among these, traumatic events, even of an iatrogenic nature, have been identified as causative factors for nonspontaneous STA pseudoaneurysms. Regional pain and tenderness, troublesome pulsations of the mass, cosmetic concerns as well as the risk of bleeding warrant a thorough evaluation and a definite interventional approach to the condition.

CASE DESCRIPTION

A 21-year-old Caucasian male searched medical advice for a growing, tender, and pulsatile mass on his right temple, with isolated and short episodes of lancinating sensations, after sustaining a blunt trauma following a hit with a stick half a year before the admission. Enhanced cranial computed tomography and angiography confirmed the diagnosis of an STA pseudoaneurysm. A direct percutaneous aspiration, as well as ultrasonography, was performed prior to the neurosurgical intervention, with the complete removal of the mass.

CONCLUSIONS

STA pseudoaneurysms require a careful evaluation and a conclusive approach in order to avoid the risk of a growing mass and other nonremote complications such as bone erosions and bleeding. Different treatment options are available, including endovascular obliteration and embolization, however, surgical removal after ligation of the afferent and efferent segments of the vessel seem to be highly effective.

True aneurysms of the superficial temporal artery: Diagnosis and treatment

OBJECTIVES

True aneurysms arising from the superficial temporal artery (STA) are quite uncommon. The present study reviews the surgical experience with true STA aneurysms to describe the clinical features and treatment options.

METHODS

This study comprised of 12 patients (6 female; mean age, 44.7 years) of spontaneous aneurysms of the STA who have undergone the surgical or endovascular treatment. All the patients had no history of trauma or surgery to the head and neck. The clinical presentation, radiographic findings, pathological and laboratory data, and treatment outcomes were retrospectively analyzed.

RESULTS

A pulsatile and progressively growing lump in the STA area was the symptom leading to clinical attention. None neurological defects existed. Six patients had frontal lesions, two had parietal and the remaining 4 patients had preauricular region aneurysms. Imaging studies revealed that the subcutaneous mass was a saccular aneurysm accompanied by the afferent and efferent vessels. The lesions ranged in size from 8 to 23 mm (mean, 11.7 mm). Aneurysm trapping and excision was performed in 11 patients. Pathological examination confirmed a true aneurysm of the STA.

CONCLUSIONS

True STA aneurysms are usually discovered as a pulsating mass over the temple and their diagnosis could be done with ultrasonography, and computed tomography and magnetic resonance angiography. Simple ligation and resection of the aneurysm is safe and curative.

A true aneurysm of the superficial temporal artery: Is there an underlying pre-disposition to such rarities?

INTRODUCTION

A 32 year old man presented to our vascular clinic with a lump over the left eyebrow. It had become larger in size and was cosmetically unacceptable.

PRESENTATION OF CASE

Clinical examination of the lump demonstrated a pulsatile swelling consistent with an aneurysm of the superficial temporal artery (STA). Doppler ultrasound demonstrated arterial flow within the lump that could be controlled with pressure over the proximal branch of the vessel. The STA aneurysm was excised under local anaesthesia by ligation of the feeding and draining branches. It measured 3.4cm×3.7cm. Histological examination confirmed a rare finding of a true aneurysm of the STA.

DISCUSSION

Aneurysms are classified into false or true types, with false aneurysms of the STA accounting for 95% of cases reported. It has therefore been suggested that true aneurysms of the STA may develop from a yet unknown pre-existing vessel condition. The histological findings in our case demonstrated myxoid/mucoid deposits replacing elastin fibres of the media layer, in addition to cystic lesions seen in the adventitia. These features were thought to be nonspecific but have been reported in rare conditions known as cystic adventitial disease and cystic medial necrosis. Such is their obscurity that we speculate that both of these may represent variations of the same underlying pathology. As myxoid/mucoid changes are also noted in more well-known connective tissue disorders including Marfan's syndrome, imaging was arranged to screen our patient for thoracic and abdominal aneurysms. These proved negative and there were no Marfanoid features noted prior.

CONCLUSION

Aneurysms of the STA are easily treated by surgical excision. This should be considered when they become large, painful or are cosmetically undesirable. Unusual histological findings in the specimen may indicate a connective tissue disorder that should be investigated if indicated.

A true aneurysm of the zygomatic orbital artery: first case report in the literature

A 33-year-old man presented with a pulsatile mass in the left temporal region; about 1 year before the current presentation, the swelling had arisen on the upper lateral border of the orbital arch and increased in recent months. His medical history was negative for accidental or iatrogenic head injury. Color echo Doppler and angio-computed tomography demonstrated a fusiform aneurysm of the zygomatic orbital artery, a branch of the superficial temporal artery. Blood tests were negative for human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) markers. Aneurysmectomy under local anesthesia was performed. Histology of the surgical specimen confirmed the diagnosis of a true aneurysm measuring 8.4 × 5.7 mm, which showed no atherosclerotic degeneration of the vessel walls; the lumen was filled by a recent thrombus but without inflammatory cells. Surgical treatment is indicated for the prevention of rupture, the relief of pain when present, and the removal of facial defects. To the authors' knowledge, this is the first case in the literature of a true aneurysm of the zygomatic orbital artery.

Superficial temporal artery aneurysm: Diagnosis and treatment options

BACKGROUND

Superficial temporal artery (STA) aneurysms are an uncommon entity and mostly described in case studies. The purpose of this review was to show the studied clinical presentation, diagnostic modalities, and treatment modalities of STA aneurysms.

METHODS

A review was performed of reports on STA aneurysms published until December 2010, using the MEDLINE and Cochrane databases.

RESULTS

One hundred sixty-six pseudoaneurysms and 20 true aneurysms were described. The majority of patients presented with a painless pulsatile mass. Historically, angiography was most often used, but ultrasound scan, CT, and MRI may be superior. Surgical resection was performed in 128 pseudoaneurysms and 20 true aneurysms with 1 recurrence and few complications. Endovascular approaches were used in 13% of pseudoaneurysms with an 80% success rate.

CONCLUSION

Pseudoaneurysms are mostly the result of blunt trauma as opposed to true aneurysms which usually occur spontaneously. Surgical resection is a safe treatment modality, but endovascular treatment might be considered in a selected group of patients. © 2012 Wiley Periodicals, Inc. Head Neck, 2013.

Degenerative (true) superficial temporal artery aneurysm: a case report with review of literature

This is a case report of a 72-year-old female who presented to our clinic with right temple mass that was found incidentally on a magnetic resonance imaging (MRI) of her head about 2 years ago, as part of a stroke workup. However, it was thought to be a sebaceous cyst and left as such. The patient then experienced a rapid increase in the size of the mass about 2 weeks prior to her presentation to us. On examination, she had a 2 × 2 cm pulsating aneurysmal mass over the right temporal fossa, which was felt to be an aneurysm of the superficial temporal artery and was confirmed by a color duplex ultrasound examination. Open surgical resection with primary ligation of both proximal and distal branches was achieved under local anesthesia. Pathology confirmed a true (degenerative) aneurysm of the superficial temporal artery. Her postoperative course was uneventful. This case report describes this rare entity along with a review of the literature.