Intracranial vascular lesions associated with small epidural hematomas.
OBJECTIVE
We studied the angiographic findings in patients with small epidural hematomas and cranial fractures crossing over the trajectory of the middle meningeal artery and its branches. Additionally, the occurrence of traumatic vascular lesions and their clinical relevance and treatment are discussed.


METHODS
A consecutive analysis was performed for 24 patients who harbored small epidural hematomas in middle meningeal artery topography associated with cranial fractures. Computed tomographic scans and plain x-ray studies were used to diagnose linear cranial fractures. Patients with large epidural hematomas or associated traumatic lesions were excluded from the study. Selective ipsilateral external carotid angiograms were obtained, and an endovascular procedure was performed if any vascular injury was evidenced.


RESULTS
In all patients with cranial fractures crossing over the middle meningeal artery and its branches, some kind of vascular lesion was seen. Two types of findings were noted: active extravasation of the contrast medium (71%) and pseudoaneurysms (29%). Early filling of diploic vessels was found in 8.3% of fractures concomitantly with active extravasation. Embolization was performed in all patients. No additional enlargement of the epidural hematoma was observed, and the postoperative period was uneventful.


CONCLUSIONS
This study shows that pseudoaneurysms and active extravasation of contrast are common findings in this subset of patients. Although the natural history of these lesions is still poorly understood, additional investigation with ipsilateral external carotid angiography may be recommended, considering the potentially catastrophic consequences of late rupture.
de Andrade
Almir F
AF
Division of Neurosurgery, University of São Paulo School of Medicine, São Paulo, Brazil.
Figueiredo
Eberval G
EG
Caldas
Jose G
JG
Paiva
Wellingson S
WS
De Amorim
Robson L O
RL
Puglia
Paulo
P
Frudit
Michel
M
Teixeira
Manoel J
MJ
D000293:Adolescent; D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D001930:Brain Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008576:Meningeal Arteries / Q000473:pathology; D008875:Middle Aged; D012887:Skull Fractures / Q000150:complications