Traumatic middle meningeal artery pseudoaneurysm: Case report and review of literature.

Traumatic aneurysms represent less than 1 percent of intracranial aneurysms and middle meningeal artery pseudoaneurysms are even rare. Traumatic aneurysms are usually pseudoaneurysms formed by the rupture of all the layers of the vessel wall. They are associated with high mortality as they can present as epidural, subdural, and rarely intraparenchymal hematoma. However, only nine cases of traumatic pseudoaneurysms of middle meningeal artery are reported that have presented as an acute intracerebral hematoma. We report a case of ruptured pseudo aneurysm of middle meningeal artery presenting with intraparenchymal hematoma in which hematoma evacuation and aneurysm excision was done immediately. The patient recovered well in the post-operative period. In addition, we reviewed all cases of middle meningeal artery pseudoaneurysms reported in the literature either as extradural hematomas, subdural/intraparenchymal hematomas, or subarachnoid hemorrhages. However, identifying the location of the aneurysm intraoperatively may be challenging as the hematoma may obscure the same. Distance from the sphenoid ridge may serve as a good intraoperative guide. Intraoperative localization along with surgical evacuation if done immediately can lead to gratifying results.