A rare case of mixd pial and dural arteriovenovs malformation in the left frontal convexity is reported. This arteriovenous malformation is supplied from the left middle meningeal artery and small pial vessels and drained into the superior sagittal sinus. This arteriovenous malformation was totally excised without artificial emoblization of the left middle meningeal artery.
Arteriovenous Malformations* ; Meningeal Arteries ; Superior Sagittal Sinus

Fifty four preparations of the cavernous sinus from twenty seven cadavers were studied in detail under microscopic magnification, with special attention to nerves and arteries related to the wall of the sinus. Significant findings were: 1) Three types of relationship between the nerves and arteries in relation to the wall of the sinus were found. Type I: The nerves III, IV and V-1 were embedded in the lateral wall, and the internal carotid artery(I.C.A.) and nerve IV passed through the cavity of the sinus(26 specimens, 48%), Type II: The cavity of the sinus was divided into two compartments by a septum close to the lateral wall, with nerves VI and V-I located within the septum(18 specimens, 33%), Type III: Anatomy was similar to the type I, except that the I.C.A. was included in the medial or lateral wall(10 specimens, 19%). 2) Arterial variations branching from the intracavernous portion of the I.C.A. were classified into four types. Type I: Meningohypophyseal trunk arising from I.C.A.(28 specimens). Type II: Dorsal meningeal artery from I.C.A.(10 specimens). Type III:Tentorial artery from I.C.A.(4 specimens). Type IV: Meningohypophyseal trunk from I.C.A. in addition, the artery of inferior cavernous sinus(12 specimens). 3) The main three brahcnes of the intracavernous portion of the I.C.A. were the meningohypophyseal artery, which was presented presented in 100% of our specimens, the artery of inferior cavernous sinus(78%), and McConnell's capsular artery(43%). Intracavernous origin of the ophthalmic artery were observed in four specimens(8%). 4) The surgical triangle spaces were found to be present in all our specimens, which were formed by the superior margin of it with the lower margin of nerve IV and by the inferior margin with the upper margin of nerve V-I.
Arteries ; Cadaver ; Cavernous Sinus* ; Meningeal Arteries ; Ophthalmic Artery

This case report describes a variation in the course of the accessory meningeal artery relative to the mandibular nerve in the infratemporal fossa. An accessory meningeal artery running superficially to the posterior division of mandibular nerve was found bilaterally in the cadaver of a 95-year-old male. It was observed by a topographic examination followed by a detailed dissection. The accessory meningeal artery arose from the middle meningeal artery. It then passed upward and coursed superficial to the posterior division of the mandibular nerve before its division into the lingual and inferior alveolar nerves. The accessory meningeal artery subsequently ran deep and rostral to the anterior and posterior divisions of the mandibular nerve, respectively, before entering the foramen ovale. The variation in the course of the accessory meningeal artery described herein should be helpful for surgeons in approaches to the foramen ovale region and infratemporal fossa.
Cadaver ; Foramen Ovale ; Humans ; Male ; Mandibular Nerve ; Meningeal Arteries ; Running

In a series of 43 patients with intracranial meningioma, we retrospectively analysed factors influencing the development of peritumoral brain edema(PTBE). The extent of this was measured by the Edema Index(EI), obtained from the size of the meningioma and associated PTBE on a T2-weighted magnetic resonance image. We evaluated the relationship between EI and certain factors that may play a role in the development of PTBE ; namely age, size, location, and histology of the tumor, and its vascular supply(intrinsic cerebral artery or meningeal artery). Tumors in the frontal and sphenoid ridge regions tended to be associated with more extensive PTBE than these in the parietal, occipital, and infratentorial regions(p<0.05). In particular, the extent of infratentorial meningioma-associated PTBE tended to be slight. Histologically, PTBE associated with meningotheliomatous and transitional meningiomas tended to be more extensive than that associated with the fibroblastic meningiomas(p<0.05). On angiography, it was seen that for meningiomas supplied by intrinsic cerebral artery(internal carotid or veterbral artery only, or in conjunction with the meningeal artery), correlation with severe PTBE was higher than for those supplied by the meningeal artery only(p<0.05). We concluded, therefore, that location, histology, and vascular supply from the intrinsic cerebral arteries were the factors influencing PTBE.
Angiography ; Arteries ; Brain Edema* ; Brain* ; Cerebral Arteries ; Edema ; Fibroblasts ; Humans ; Meningeal Arteries ; Meningioma ; Rabeprazole ; Retrospective Studies

A case of rare complication in preoperative embolization of intracranial meningioma is reported. A 42-year old man who was diagnosed as left parietal convexity meningioma underwent embolization of feeding vessels through the selective angiography. In the process of embolization of middle meningeal artery, after superficial temporal artery occlusion, there was sudden dye leakage around the tumor on the fluoroscopy suggesting the peritumoral bleeding. On the operation we could find the large hematoma around the mass. We are reporting this rare complication with the discussion of the possible etiology.
Adult ; Angiography ; Fluoroscopy ; Hematoma ; Hemorrhage* ; Humans ; Meningeal Arteries ; Meningioma* ; Rabeprazole ; Temporal Arteries

There have been many reports of angiographic extravasation since the first description by Jamieson in 1952. Preoperative differential diagnosis between epidural and subdural post-traumatic blood collections is not always possible on the basis of cerebral angiographic signs alone, but many authors considered that extravasation of the contrast medium from a ruptured meningeal vessel is commonly considered as a definitive angiographic sign of epidural hematoma. Some authors feel that an extravasation of contrast medium from rupture of the middle meningeal artery does not necessarily indicate an epidural hematoma since it may also be formed rarely in cases of subdural or intracerebral blood collections. The authors report 6 cases of angiographic extravasation in head injury patient, 3 epidural hematoma, 2 subdural hematoma and one intracerebral hematoma.
Craniocerebral Trauma ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural ; Humans ; Meningeal Arteries ; Rupture

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.
Aged ; Aneurysm, False* ; Brain ; Cranial Fossa, Middle ; Craniocerebral Trauma ; Hematoma* ; Hemorrhage ; Humans ; Meningeal Arteries*

OBJECTIVE: Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. METHODS: Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. RESULTS: All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed > or =2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. CONCLUSION: Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.
Cavernous Sinus ; Central Nervous System Vascular Malformations* ; Fistula ; Humans ; Meningeal Arteries ; Punctures ; Superior Sagittal Sinus

We report a case of dural arteriovenous fistula (DAVF) that showed spontaneous conversion of venous drainage pattern from Borden type II to type III within a four month period of follow-up. Upon admission, the patient presented with aggravated neurologic status and newly developed seizure. After admission, endovascular embolization was performed through the middle meningeal artery with Onyx®. Complete obliteration of dural arteriovenous shunt was confirmed by angiography, and the patient's clinical symptoms improved. Although most cases of DAVF show benign clinical course and conversion pattern, close follow-up is required to detect potential aggravation.
Angiography ; Central Nervous System Vascular Malformations* ; Drainage* ; Follow-Up Studies ; Humans ; Meningeal Arteries ; Seizures

Traumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare phenomenon, which are usually associated with head trauma such as an underlying skull fracture. They were usually known to cause acute or delayed epidural hematomas but can be associated with subdural, subarachnoid, or even intracerebral hemorrhage. Sometimes, a high mortality rate was reported in these circumferences. But the natural course of these pseudoaneurysms is not well recognized. The indication and guideline of treatment for pseudoaneurysm are also unclear. This report describes a rare case of angiographically progressive change of traumatic pseudoaneurysm of the middle meningeal artery for one week, which was treated with endovascular embolization.
Aneurysm, False* ; Cerebral Hemorrhage ; Craniocerebral Trauma ; Hematoma ; Meningeal Arteries* ; Mortality ; Skull Fractures