Aneurisma verdadeiro pós-traumático de artéria temporal / True posttraumatic aneurysm of the temporal artery

Os aneurismas de artéria temporal pós-traumático são eventos raros. Geralmente, são pseudoaneurismas. Como a causa mais frequente são ferimentos contusos, deve-se investigar todo paciente que possuir nodulação pulsátil na região da artéria temporal. O paciente apresentava protuberância pulsátil em região frontal direita há quatro meses, após queda de objeto pontiagudo, e o eco-Doppler evidenciou dilatação aneurismática. Assim, foi indicada sua excisão, que foi realizada com sucesso. O exame anatomopatológico demonstrou aneurisma verdadeiro traumático de artéria temporal superficial. Ocorrem devido ao fato de a artéria temporal superficial se localizar diretamente sobre o periósteo, o que a torna muito superficializada. Os aneurismas verdadeiros pós-traumáticos de artéria temporal são extremamente raros e podem ser confundidos com diversas outras afecções, como lipomas e cistos sebáceos.

Posttraumatic aneurysms of the temporal artery are rare events and are generally pseudoaneurysms. Since the most frequent cause is blunt injury, all patients with a pulsating nodule in the region of the temporal artery should be investigated. This patient presented with a pulsating protuberance in the right frontal area with onset 4 months previously after being hit by a falling sharp object. Doppler ultrasonography showed evidence of aneurysmal dilatation, which was excised successfully. Pathology results demonstrated a true traumatic aneurysm of the superficial temporal artery. They occur because the superficial temporal artery is located directly over the periosteum, meaning it is very superficial. True posttraumatic aneurysms of the temporal artery are extremely rare and may be confused with many other conditions, such as lipomas and sebaceous cysts.

The anatomical basis for surgical preservation of temporal muscle.

OBJECT: Mobilizing the temporal muscle is a common neurosurgical maneuver. Unfortunately, the cosmetic and functional complications that arise from postoperative muscular atrophy can be severe. Proper function of the muscle depends on proper innervation, vascularization, muscle tension, and the integrity of muscle fibers. In this study the authors describe the anatomy of the temporal muscle and report technical nuances that can be used to prevent its postoperative atrophy. METHODS: This study was designed to determine the susceptibility of the temporal muscle to injury during common surgical dissection. The authors studied the anatomy of the muscle and its vascularization and innervation in seven cadavers. A zygomatic osteotomy was performed followed by downward mobilization of the temporal muscle by using subperiosteal dissection, which preserved the muscle and allowed a study of its arterial and neural components. The temporal muscle is composed of a main portion and three muscle bundles. The muscle is innervated by the deep temporal nerves, which branch from the anterior division of the mandibular nerve. Blood is supplied through a rich anastomotic connection between the deep temporal arteries (anterior and posterior) on the medial side and the middle temporal artery (a branch of the superficial temporal artery [STA]) on the lateral side. CONCLUSIONS: Based on these anatomical findings, the authors recommend the following steps to preserve the temporal muscle: 1) preserve the STA; 2) prevent injury to the facial branches by using subfascial dissection; 3) use a zygomatic osteotomy to avoid compressing the muscle, arteries, and nerves, and for greater exposure when retracting the muscle; 4) dissect the muscle in subperiosteal retrograde fashion to preserve the deep vessels and nerves; 5) deinsert the muscle to the superior temporal line without cutting the fascia; and 6) reattach the muscle directly to the bone.

Human vascular endothelium heterogeneity. A comparative study of cerebral and peripheral cultured vascular endothelial cells.

BACKGROUND AND PURPOSE: Hormones, neurotransmitters, and autacoids play a key role in the regulation of vascular tone as a result of their interaction with the endothelium. The aim of this study was to compare selected properties of three human endothelial cell lines isolated from cerebral pial arteries (PEC) and two peripheral vessels, the superficial temporal (SEC) and omental (OEC) arteries. METHODS: Intracellular free calcium concentration ([Ca2+]i) and receptor protein expression were measured in characterized primary cultures of human endothelial cells. RESULTS: All cell lines labeled positively for factor VIII/von Willebrand factor. Growth rate and constitutive release of endothelin-1, expressed as a function of protein, were both significantly lower in cerebral cells (PEC) than in endothelial cells derived from peripheral vessels. Basal [Ca2+]i measured with the fluorescent calcium indicator fura 2-AM (2 mumol/L) did not differ in either of the three cell lines. Although PEC responded to endothelin-1 (0.1 mumol/L) and vasoactive intestinal peptide (1 mumol/L) by a twofold to threefold increase in [Ca2+]i, OEC were unresponsive to these peptides. Moreover, the calcium response to alpha-thrombin (10 nmol/L) was greater in cerebral (PEC) than in peripheral (SEC, OEC) endothelial cells, while bradykinin (100 nmol/L) increased [Ca2+]i to a similar level in all three cell types. CONCLUSIONS: This study demonstrates that endothelial cells from different sites of the vasculature exhibit different growth rates and vary in their response to agonists.