case_images: PMC10927187_01
case_images: (a-c) Head computed tomography reveals a cerebral contusion in the right temporal lobe (black arrow), right pneumoencephalopathy (circle), and a left petrous bone fracture (white arrow).
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case_images: F1
case_images: Computed tomography (CT) of the head suggested right traumatic subarachnoid hemorrhage, cerebral contusion of the right temporal lobe, right pneumoencephalopathy, and longitudinal fracture of the left petrous bone [Figure 1].
case_images: Head magnetic resonance imaging shows the right middle meningeal artery and a vein, indicating shunt disease (white arrow).
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case_images: F2
case_images: It suggested the involvement of the right MMA and a vein, indicating the occurrence of shunt disease [Figure 2].
case_images: (a and b) Early (a) and late (b) arterial phases of external carotid arteriography suggest perfusion from the middle meningeal artery into the superior sagittal sinus, diploic vein, and pterygoid venous plexus (arrow).
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case_images: F3
case_images: Cerebral angiography of the external carotid artery (ECA) performed seven days post-injury aided in the visualization of the MMA, MMV, diploic vein (DV), superior sagittal sinus (SSS), and pterygoid plexus (PP) [Figure 3].
case_images: (a and b) Cone-beam computed tomography (a) and schema (b). Direct shunt from the middle meningeal artery (MMA) to middle meningeal vein (MMV)(arrow) along the bone fracture line (ball arrow). Proximal MMA with contrast (arrowhead) and distal MMA without contrast (double arrowhead).
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case_images: F4
case_images: However, in the regions above the shunt, the entire contrast agent in the MMA perfused the MMV, causing the MMA to appear darkened and showing a tram track appearance [Figure 4].
case_images: (a and b) Shunt point is identified (arrow), and seven coils are used for occlusion. (c) After coil embolization, the middle meningeal artery is no longer visualized.
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case_images: F5
case_images: PP were absent [Figure 5]. Postoperatively, the headache symptoms experienced by the patient had improved; she was discharged on the 20th day after the injury and exhibited no recurrence at the 1-year follow-up.