Kpelao E, Beketi K A, Ahanogbe K M H, Moumouni A K, Doleagbenou A K, Egu K, Ntimon B, Tchaou M, Egbohou P
Department of Neurosurgery, Sylvanus Olympio University Hospital Center, Togo.
Department of Radiology, Sylvanus Olympio University Hospital Center, Togo.
Surg Neurol Int. 2017 Aug 1;8:172. doi: 10.4103/sni.sni_159_17. eCollection 2017.
Aneurysms of meningeal middle artery (MMA) are extremely rare. These aneurysms are of two types: true aneurysm and pseudoaneurysm. The true type is usually seen with pathologic conditions. Pseudoaneurysms, on the other hand, are associated with a skull fracture. Epilepsy caused by MMA aneurysm has never been described to our knowledge. We report a case of true aneurysm isolated from MMA revealed by epilepsy.
A 57-year-old patient with a history of high blood pressure developed epilepsy which was treated by valproic acid. Initial scalp electroencephalography (EEG) showed seizure activity arising from the right temporal area. Epilepsy had become drug-resistant. Cerebral angiography revealed an aneurysm of the right middle meningeal artery without any other intraparenchymal anomaly. The interrogation did not reveal any history of family aneurysm. The patient underwent surgery with coagulation of the aneurysm and the MMA. The aneurysm was intradural in contact with the temporal cortex, and the surrounding brain tissues were preserved. The operative follow-up was favorable with amelioration of convulsions with a single antiepileptic. We planned to stop antiepileptic treatment according to electroencephalograms.
Aneurysms of the MMA are rare. Their mode of revelation by seizures is unusual. The factors of rupture are not known. When isolated, their physiopathology is identical to that of the aneurysms of the Willis polygon. Their management uses the same techniques as for other cerebral aneurysms.
脑膜中动脉（MMA）动脉瘤极为罕见。这些动脉瘤有两种类型：真性动脉瘤和假性动脉瘤。真性动脉瘤通常见于病理状况。另一方面，假性动脉瘤与颅骨骨折有关。据我们所知，从未有过关于MMA动脉瘤引起癫痫的描述。我们报告一例因癫痫而发现的孤立于MMA的真性动脉瘤病例。
一名有高血压病史的57岁患者出现癫痫，接受丙戊酸治疗。最初的头皮脑电图（EEG）显示癫痫活动起源于右侧颞区。癫痫已产生耐药性。脑血管造影显示右侧脑膜中动脉有一个动脉瘤，无任何其他脑实质内异常。询问未发现家族性动脉瘤病史。患者接受了动脉瘤和MMA凝固术。动脉瘤位于硬膜内，与颞叶皮质接触，周围脑组织得以保留。手术随访情况良好，使用单一抗癫痫药物后惊厥有所改善。我们计划根据脑电图停止抗癫痫治疗。
MMA动脉瘤罕见。其以癫痫发作作为首发表现的方式不寻常。破裂因素尚不清楚。当孤立存在时，其病理生理学与Willis环动脉瘤相同。其治疗采用与其他脑动脉瘤相同的技术。
