Pseudoaneurysms of the superficial temporal artery are rare lesions. They present as slowly growing pulsating masses of the face or scalp. The common causes are blunt head trauma, penetrating wounds or interventional procedures. We report here on a rare case of superficial temporal artery pseudoaneurysm in a 44-year-old woman who presented with a pulsating mass, and this mass occurred on the left temporal area 2 weeks after performing a skin punch biopsy.
Adult ; Aneurysm, False ; Biopsy ; Female ; Head Injuries, Penetrating ; Humans ; Scalp ; Skin ; Temporal Arteries

Pseudoaneurysm of the superficial temporal artery is very rare and can potentially be a critical cause of facial masses. Most pseudoaneurysms form as a result of blunt trauma and present as painless, pulsatile tumors that may be associated with neuropathic findings and enlarged size. They can be accurately diagnosed through physical examination alone. The treatment of choice is surgical ligation and resection. We present a case of traumatic pseudoaneurysm of the superficial temporal artery caused by blunt injury and discuss pertinent diagnosis and treatment option.
Aneurysm, False* ; Diagnosis ; Facial Injuries ; Ligation ; Physical Examination ; Temporal Arteries* ; Wounds, Nonpenetrating

Pseudoaneurysm arising from the superficial temporal artery (STA) is very rare and is most commonly caused by blunt trauma. Most pseudoaneurysms of the STA usually present as a painless pulsating mass, with concomitant symptoms according to location, and their size may rapidly increase. The treatment of choice is ligation and resection. We present a case of pseudoaneurysm arising from STA after a penetrating injury caused by broken glass. We describe the history, findings of physical examination, Doppler sonography, angiography, histopathology, and the outcome of treatment. We also include a brief review of this condition.
Aneurysm, False/surgery ; Aneurysm, False/etiology* ; Aneurysm, False/diagnosis ; Angiography, Digital Subtraction ; Case Report ; Human ; Male ; Middle Age ; Temporal Arteries/surgery ; Temporal Arteries/pathology ; Temporal Arteries/injuries* ; Thrombosis/etiology ; Ultrasonography, Doppler ; Wounds, Penetrating/surgery ; Wounds, Penetrating/complications*

One case of congenital cutis aplasia is presented. The defect involved includes full-thickness skin defect of scalp and cranium. The patient was treated with debridement of dirty necrosed crust which covered exposed dura mater and with double opposing rotation flap including pericranium for bone regeneration. The donor site was covered with skin graft from right thigh. During operation, the superficial temporal artery was found to be short and weak. And after operation, the margin of flap were congested and finally necrotized. The necrotic wound was treated with conservative management. The vascular impairment is thought to be main course of congenital cutis aplasia. So we conclude that the treatment of choice is conservative management or careful flap surgery for coverage of defect area.
Bone Regeneration ; Debridement ; Dura Mater ; Estrogens, Conjugated (USP) ; Humans ; Scalp ; Skin ; Skull ; Temporal Arteries ; Thigh ; Tissue Donors ; Transplants ; Wounds and Injuries

We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.
Acellular Dermis ; Arachnoid ; Cerebrospinal Fluid ; Cerebrum ; Decompressive Craniectomy ; Dermis* ; Dura Mater ; Female ; Free Tissue Flaps* ; Humans* ; Intracranial Hemorrhages ; Methicillin Resistance ; Middle Aged ; Scalp* ; Staphylococcal Infections ; Superficial Back Muscles* ; Suppuration ; Temporal Arteries ; Wounds and Injuries

Traumatic pseudoaneurysms of middle meningeal artery (MMA) and medial sphenoid wing dural arteriovenous fistula (dAVF) are rare. These lesions usually result from traumatic brain injury, and associated with skull fracture. In this paper, the authors report a case of a patient with a ruptured traumatic pseudoaneurysm of MMA and medial sphenoid wing dAVF presented with an intracerebral hemorrhage in the left temporal region and subarachnoid hemorrhage. These lesions were completely obliterated by endovascular treatment, and the patient was recovered without any neurologic deficit. However, 18-day after the procedure, delayed neurologic deficits were developed due to cerebral vasospasm.
Aneurysm, False* ; Arteriovenous Fistula ; Brain Injuries ; Central Nervous System Vascular Malformations* ; Cerebral Hemorrhage ; Humans ; Meningeal Arteries* ; Neurologic Manifestations ; Skull Fractures ; Subarachnoid Hemorrhage* ; Subarachnoid Hemorrhage, Traumatic ; Temporal Lobe ; Vasospasm, Intracranial

OBJECTIVE: To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap. METHODS: A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed. There were 9 males and 5 females with a median age of 9.5 years (range, 3-38 years). The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar (8 cases) or congenital melanocyte nevus (6 cases). The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm. Before operation, the indocyanine green angiography was used to map the superficial temporal artery and vein, and to analyze the relationship of the arteries and veins. The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases. The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel, and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap. The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases. The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein. Among the 12 cases, the frontal branch of superficial temporal vein was used as the outflow in 4 cases, and the parietal branch was used as the outflow in 8 cases. The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm. The skin pedicles were divided at 3 weeks after the flap transfer. RESULTS: Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein. Individual differences existed in the location where the frontal branch of the superficial temporal artery entered the forehead. The superficial temporal vein had great variability and did not follow the artery. One patient had expander-related complication, which resulted in 3-cm flap necrosis. The necrotic tissue was debrided and repaired with skin grafting. The other flaps totally survived and the incisions healed by first intention. All patients were followed up 2-24 months, with a median of 11.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. Hypertrophic scar was not observed in recipient or donor site. All patients were satisfied with the reconstructive outcomes. CONCLUSION Indocyanine green angiography can clearly visualize the course and the branches of the superficial temporal arteries and veins, which can help surgeons understand the position, distribution, and concomitant relationship of the superficial temporal vessels, and make a rational surgical plan of the forehead flap.
Male ; Female ; Humans ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Temporal Arteries/surgery* ; Indocyanine Green ; Forehead/surgery* ; Retrospective Studies ; Skin Transplantation ; Angiography ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Treatment Outcome

It is well known that in studying the effects of hypophysectomy, removal of the pituitary must be essentially complete without injury of the neighboring region of the brain. We devised a new method of total hypophysectomy using microsurgical instruments, and observed the effects on the gonad in the dog. 1. Operative method. The animals were anesthetized with pentobarbital sodium 30 mg/kg body weight and then a wooden bar, about 5 cm in diameter, was inserted in the mouth to displace the mandibular angle anteriodownwardly. After aseptic draping at operative field vertical incision from the midline of the vertex to just behind the mandibular angle was made on the right side of frontotemporal region. Temporal muscles were also incised vertically and retractor was applied to expose the frontotemporal bone. Following wide craniectomy down to the base of middle cranial fossa and careful opening of the dura mater, temporal lobe was retracted upward and medially at the tip of the middle cranial fossa with narrow brain retractor. As the 3rd cranial nerve and internal carotid artery were exposed, arachnoid membrane was torn with microforceps and microscissors, and aspirated the cerebrospinal fluid slowly to obtain wider exposure, then elevated posterior communicating artery to expose the pituitary body and stalk. The stalk was clipped or crushed with microforceps and then sectioned with microscissors, then pituitary body was isolated with microelevator and removed in a piece with microforceps or sucked out with suction. The wound was closed in layers. 2. Postoperative management and the results. Among these experimental animals, 6 dogs were observed for the period of 43-77 days, and in 6 dogs dexamethasone was given intramuscularly for one or two weeks following hypophysectomy, the rest were used as normal control. Following clinical observation, these animals were sacrificed with intracarotid arterial infusion of 0% neutral formalin solution and removed the brain and the gonads, and fixed in 10% neutral formalin solution. The removed brain was examined and pituitary fossa was also scrutinized. The gonads were stained with hematoxylin-eosin. Periodic acid Sciff(PAS) and toluidine blue staining methods. The observed results were as follows: 1) Average diameter of testicular seminiferous tubules was 0.17 mm in normal control group. but became markedly reduced to 0.10 mm following hypophysectomy. With administration of dexamethasone for 1 and 2 weeks, diameter ranged 0.09 mm and 0.13 mm, respectively. 2) Testicular lesions in hypophysectomy group were characterized by marked reduction of spermatogenic activity, representing stage of germ cell aplasia with loss of spermatogonia, spermatocytes and spermatids. But in cases with dexamethasone administration, the pattern resembled various stages of germ cell arrest as with increased mitotic activities of spermatogonia and spermatocytes. 3) Those numerical alternations of spermatogenic cells accompanied secondary histological manifestations which included relative increase of Sertoli cell, mild thickening of basement membrane and Leydig cell hyperplasia. The findings following administration of dexamethasone became modified to reveal less prominent Sertoli cells and rather distinct Leydig cell clustering. Basement membrane thickening remained unchanged. 4) Ovarian changes in hypophysectomized dogs on the other hand, disclosed reduction of overall size accompanying decrease in number and size of Grafian follicles, atrophy of follicular and cortical stremal cells, degeneration of cva and absence of corpus luteum. Follicular and stromal cells appeared responded to administration of dexamethasone relatively in considerable degree. 5) Mast cells normally distributed mainly in the tunica albuginea of both testis, and ovary, increased following hypophysectomy to extend along fibrotic interstitial tissue of testis, but became reduced to the level of normal control group following administration of dexamethasone.
Animals ; Arachnoid ; Arteries ; Atrophy ; Basement Membrane ; Body Weight ; Brain ; Carotid Artery, Internal ; Cerebrospinal Fluid ; Corpus Luteum ; Cranial Fossa, Middle ; Cranial Nerves ; Dexamethasone ; Dogs* ; Dura Mater ; Female ; Formaldehyde ; Germ Cells ; Gonads* ; Hand ; Hyperplasia ; Hypophysectomy* ; Mast Cells ; Membranes ; Mouth ; Ovary ; Pentobarbital ; Periodic Acid ; Seminiferous Tubules ; Sertoli Cells ; Spermatids ; Spermatocytes ; Spermatogonia ; Stromal Cells ; Suction ; Temporal Lobe ; Temporal Muscle ; Testis ; Tolonium Chloride ; Wounds and Injuries