title: Onyx embolization of an intraosseous pseudoaneurysm of the middle meningeal artery in a patient with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome.
abstract: A 13-year-old boy with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome presented with an enlarging "lump" on his right forehead. A head CT scan revealed a polyostotic fibrous dysplasia involving the entire skull. A 3.4-cm right frontal osseous cavity and an overlying right forehead subcutaneous soft-tissue mass were seen, measuring 5.2 cm in diameter and 1.6 cm thick. Ultrasound of the cavity and overlying mass showed swirling of blood and an arterialized waveform. MRI revealed an en plaque meningioma underlying the cavity. An intraosseous pseudoaneurysm fed by 3 distal anterior division branches of the right middle meningeal artery (MMA) with contrast extravasation was found on angiography. Two MMA feeders were embolized with Onyx, with anterograde filling of the intraosseous cavity with Onyx. A small pocket of residual intracavity contrast filling postembolization from a smaller third MMA feeder eventually thrombosed and the forehead lump regressed.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Fabio
authors.initials: F
authors.lastname: Settecase
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Nicholson
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Amans
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Van V
authors.initials: VV
authors.lastname: Halbach
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Dowd
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hetts
mesh_terms: D000293:Adolescent; D017541:Aneurysm, False / Q000150:complications / Q000628:therapy*; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods*; D005359:Fibrous Dysplasia, Polyostotic / Q000150:complications; D055652:Gray Platelet Syndrome / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008576:Meningeal Arteries; D008579:Meningioma / Q000150:complications / Q000628:therapy*; D011145:Polyvinyls / Q000627:therapeutic use*; D013635:Tantalum / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: C000598428:Onyx 34; D011145:Polyvinyls; D013635:Tantalum; D004121:Dimethyl Sulfoxide
keywords: GPS = gray platelet syndrome; MAC = McCune-Albright syndrome; MMA = middle meningeal artery; McCune-Albright syndrome; Onyx; calvaria; endovascular; gray platelet syndrome; meningioma; pseudoaneurysm; vascular disorders