Diagnosis and treatment of intracranial traumatic pseudoaneurysms

doi:10.3877/cma.j.issn.2095-9141.2016.05.003

Abstract

Abstract:

Objective

To investigate the characteristics of traumatic intracranial pseudoaneurysms and the surgical treatment ethods and outcome.

Methods

The information of a total of 14 cases of traumatic intracranial pseudoaneurysms from October 2008 to December 2014 was analyzed retrospectively about the clinical manifestations, imaging characteristics and surgical method. One case with cavernous sinus segment carotid pseudoaneurysm underwent ECA-MCA bypass and aneurysm isolated after blood flow after blocking test (Matas test); ten patients underwent endovascular interventional embolization; three patients underwent pseudoaneurysm neck reinforcement or clipping.

Results

Three cases underwent surgical removal of the aneuryms and had the pathological specimens. The pathological examination showed compound for a large number of thrombosis and machine, without inelastic fiber or smooth muscle cells and other normal blood vessels. It conforms to the characteristics of pseudoaneurysms. These patients’ GOS score when discharged from hospital including 5 in 6 cases, 4 in 4 cases and 3 in 4 cases. All the patients were followed up from 6 months to 6 years, 10 cases DSA and CTA examination showed aneurysms disappear and the parent artery patency. All patients were followed up without bleeding again.

Conclusion

Traumatic intracranial pseudoaneurysms is a special kind of aneurysm, with high operation risk and difficult. It is necessary to fully understand the characteristics of pseudoaneurysms and the status of compensatory intracranial vascular preoperative. If the characteristics of pseudoaneurysms can be fully understood and individualized surgical treatment can be undergone, the patients could have a good outcome.

Key words: Traumatic brain injury, Intracranial aneurysm, Pseudoaneurysm

Gang Li, Hongzun Chen, Chengye Liu, Yangrui Zheng. Diagnosis and treatment of intracranial traumatic pseudoaneurysms[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(05): 271-277.

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Figures/Tables 5

References 15

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序号	年龄/性别	损伤至再出血时间（d）	临床表现	动脉瘤部位	治疗方法	结果（GOS）
01	63/男	67	大量口鼻出血	R?ICA	颈外动脉?大脑中动脉搭桥并动脉瘤孤立	3
02	39/女	7	蛛网膜下腔出血，脑出血	ACA	动脉瘤颈破口夹闭术	5
03	27/男	16	蛛网膜下腔出血	R?ICA	支架辅助弹簧圈栓塞	3
04	16/男	28	蛛网膜下腔出血	L?PICA	动脉瘤颈破口夹闭术	5
05	50/男	13	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	4
06	14/男	27	蛛网膜下腔出血	ACA	弹簧圈栓塞	3
07	33/男	22	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	5
08	46/女	26	蛛网膜下腔出血，脑出血	R?ICA	支架辅助弹簧圈栓塞	4
09	32/男	17	蛛网膜下腔出血	R?PICA	弹簧圈栓塞	3
10	22/女	37	蛛网膜下腔出血	R?ICA	支架辅助弹簧圈栓塞	5
11	19/男	29	蛛网膜下腔出血，脑出血	L?ICA	支架辅助弹簧圈栓塞	5
12	17/女	6	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	4
13	29/男	36	蛛网膜下腔出血	R?MCA	动脉瘤颈破口夹闭术	4
14	40/男	18	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	5

序号	年龄/性别	损伤至再出血时间（d）	临床表现	动脉瘤部位	治疗方法	结果（GOS）
01	63/男	67	大量口鼻出血	R?ICA	颈外动脉?大脑中动脉搭桥并动脉瘤孤立	3
02	39/女	7	蛛网膜下腔出血，脑出血	ACA	动脉瘤颈破口夹闭术	5
03	27/男	16	蛛网膜下腔出血	R?ICA	支架辅助弹簧圈栓塞	3
04	16/男	28	蛛网膜下腔出血	L?PICA	动脉瘤颈破口夹闭术	5
05	50/男	13	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	4
06	14/男	27	蛛网膜下腔出血	ACA	弹簧圈栓塞	3
07	33/男	22	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	5
08	46/女	26	蛛网膜下腔出血，脑出血	R?ICA	支架辅助弹簧圈栓塞	4
09	32/男	17	蛛网膜下腔出血	R?PICA	弹簧圈栓塞	3
10	22/女	37	蛛网膜下腔出血	R?ICA	支架辅助弹簧圈栓塞	5
11	19/男	29	蛛网膜下腔出血，脑出血	L?ICA	支架辅助弹簧圈栓塞	5
12	17/女	6	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	4
13	29/男	36	蛛网膜下腔出血	R?MCA	动脉瘤颈破口夹闭术	4
14	40/男	18	蛛网膜下腔出血	L?ICA	支架辅助弹簧圈栓塞	5

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