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Blunt Cerebrovascular Injury-Like Injury Observed in Patients With Craniofacial Self-Inflicted Gunshot Wounds. J Craniofac Surg 2021; 33:1046-1050. [PMID: 34873101 DOI: 10.1097/scs.0000000000008384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although blunt cerebrovascular injury (BCVI) is recognized as a risk factor for trauma morbidity and mortality, little is described regarding similar cerebrovascular injury (CVI) in patients with penetrating wounds. The authors aim to characterize these injuries in the craniofacial self-inflicted gunshot wound (SIGSW) population. METHODS An institutional review board (IRB)-approved retrospective nstudy was conducted on patients presenting to the R Adams Cowley Shock Trauma Center with SIGSWs between 2007 and 2016. All CVIs were categorized by location, type, and associated neurologic deficits. Demographic data, patient characteristics, additional studies, and long-term outcomes were collected. A multivariate analysis determining independent predictors of CVI in the SIGSW population was performed. RESULTS Of the 73 patients with SIGSWs, 5 (6.8%) had CVIs separate from the bullet/cavitation tract (distant CVIs) and 9 had CVIs along the bullet/cavitation tract (in-tract CVIs). A total of 55.6% of in-tract and 40% of distant injuries were missed on initial radiology read. One distant CVI patient suffered a stroke during admission. The anterior to posterior gunshot wound trajectory was positively associated with distant CVIs when compared with no CVIs (P = 0.01). Vessel dissection was more prevalent in patients with distant CVIs, when compared against patients with in-tract CVIs (P = 0.02). CONCLUSIONS Nearly 20% of craniofacial SIGSW patients have CVIs and 6.8% have BCVI-like injuries, which is 2-to-6-fold times higher than traditional BCVIs. Craniofacial SIGSWs serve as an independent screening criterion with comparable screening yields; the authors recommend radiographic screening for these patients with particular scrutiny for CVIs as they are frequently missed on initial radiographic interpretations.
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Pseudo aneurysm of the maxillary artery: A case report from the yalgado ouedraogo university hospital of ouagadougou and review of the literature. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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3
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Kudryavtsev DV, Karpov NV, Mamas'yan EA, Shishkina LV, Karnaukhov VV. [Surgical treatment of a patient with a traumatic arterial aneurysm of the M4 segment of the left middle cerebral artery. Case report and literature review]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:90-96. [PMID: 31577274 DOI: 10.17116/neiro20198304190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the study is to present the results of successful treatment of a patient with traumatic arterial aneurysm of the middle cerebral artery (MCA). MATERIAL AND METHODS A clinical case of traumatic arterial aneurysm of the M4 segment of MCA was studied. A patient with a ruptured traumatic aneurysm was transferred to Krasnogorsk City Hospital #1 for further examination and emergency surgery. RESULTS On the sixth day after surgery, the patient was discharged in a satisfactory condition with almost complete regression of neurological symptoms. CONCLUSION Treatment of traumatic arterial aneurysms requires an individual approach taking into account the past medical history, the clinical presentation, aneurysm location and anatomy, as well as the mechanism of injury. It is extremely difficult to suspect an arterial aneurysm after a patient had a traumatic brain injury as the incidence of this condition is very low. An angiographic study of cerebral vessels is needed for reliable diagnosis, not just solely performing standard computed tomography of the brain. Patients with this pathology require surgical intervention.
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Affiliation(s)
| | - N V Karpov
- Krasnogorsk city hospital #1, Krasnogorsk, Russia
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4
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Laaguili J, El Asri AC, Gazzaz M, El Hassani MR, El Mostarchid B. [False traumatic intracranial arterial aneurysm]. Pan Afr Med J 2015; 20:158. [PMID: 26113901 PMCID: PMC4469433 DOI: 10.11604/pamj.2015.20.158.5461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/31/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jawad Laaguili
- Service de Neurochirurgie de l'Hôpital Militaire Mohammed V de Rabat, Maroc
| | | | - Miloud Gazzaz
- Service de Neurochirurgie de l'Hôpital Militaire Mohammed V de Rabat, Maroc
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Han JH, Koh EJ, Choi HY, Park JS, Lee JM. Visualization of a Traumatic Pseudoaneurysm at Internal Carotid Artery Bifurcation due to Blunt Head Injury: A Case Report. Korean J Neurotrauma 2014; 10:126-9. [PMID: 27169047 PMCID: PMC4852601 DOI: 10.13004/kjnt.2014.10.2.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 12/02/2022] Open
Abstract
Traumatic intracranial pseudoaneurysms occurring after blunt head injuries are rare. We report an unusual case of subarachnoid hemorrhage (SAH) caused by rupturing of the traumatic pseudoaneurysm of the internal carotid artery (ICA) bifurcation that resulted from a non-penetrating injury. In a patient with severe headache and SAH in the right sylvian cistern, which developed within 7 days after a blunt-force head injury, a trans-femoral cerebral angiogram (TFCA) showed aneurysmal sac which was insufficient to confirm the pseudoaneurysm. We obtained a multi-slab image of three dimensional time of flight (TOF) of magnetic resonance angiography (MRA). The source image of the gadolinium-enhanced MRA revealed an intimal flap within the intracranial ICA bifurcation, providing a clue for the diagnosis of a dissecting pseudoaneurysm at the ICA bifurcation due to blunt head trauma. We performed direct aneurysmal neck clipping, without neurological deficit. A follow-up TFCA did not show either aneurysm sac or luminal narrowing. We suggest that in the patient with a history of blunt head injury with SAH following shortly, multi-slab image of 3D TOF MRA can give visualization of the presence of a pseudoaneurysm.
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Affiliation(s)
- Ju-Hee Han
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Eun-Jeong Koh
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Ha-Young Choi
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Jung-Soo Park
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
| | - Jong-Myong Lee
- Department of Neurosurgery, Chonbuk National University Medical School-Hospital, Jeonju, Korea
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6
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Rahimi-Movaghar V, Jazayeri SB, Alimi M, Abbassioun K, Amirjamshidi A. Lessons Learned from War: A Comprehensive Review of the Published Experiences of the Iranian Neurosurgeons During the Iraq-Iran Conflict and Review of the Related Literature. World Neurosurg 2013; 79:346-58. [DOI: 10.1016/j.wneu.2012.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 05/06/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
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7
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Sweeney JM, Lebovitz JJ, Eller JL, Coppens JR, Bucholz RD, Abdulrauf SI. Management of nonmissile penetrating brain injuries: a description of three cases and review of the literature. SKULL BASE REPORTS 2011; 1:39-46. [PMID: 23984201 PMCID: PMC3743592 DOI: 10.1055/s-0031-1275257] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/22/2010] [Indexed: 12/16/2022]
Abstract
Nonmissile penetrating intracranial injuries are uncommon events in modern times. Most reported cases describe trajectories through the orbit, skull base foramina, or areas of thin bone such as the temporal squama. Patients who survive such injuries and come to medical attention often require foreign body removal. Critical neurovascular structures are often damaged or at risk of additional injury resulting in further neurological deterioration, life-threatening hemorrhage, or death. Delayed complications can also be significant and include traumatic pseudoaneurysms, arteriovenous fistulas, vasospasm, cerebrospinal fluid leak, and infection. Despite this, given the rarity of these lesions, there is a paucity of literature describing the management of neurovascular injury and skull base repair in this setting. The authors describe three cases of nonmissile penetrating brain injury and review the pertinent literature to describe the management strategies from a contemporary cerebrovascular and skull base surgery perspective.
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Affiliation(s)
- Justin M Sweeney
- Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
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8
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CHO WS, BATCHULUUN B, LEE SJ, KANG HS, KIM JE. Recurrent Subdural Hematoma From a Pseudoaneurysm at the Cortical Branch of the Middle Cerebral Artery After Mild Head Injury -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:217-21. [DOI: 10.2176/nmc.51.217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Won-Sang CHO
- Department of Neurosurgery, Kangwon National University Hospital
| | | | - Seung Jin LEE
- Department of Neurosurgery, Seoul National University College of Medicine
| | - Hyun-Seung KANG
- Department of Neurosurgery, Seoul National University College of Medicine
| | - Jeong Eun KIM
- Department of Neurosurgery, Seoul National University College of Medicine
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9
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Rashid M, Razmkon A, Ziaei AR, Taghipour M. Handle with care, penetrating neurotrauma: Case report and review of literature. INDIAN JOURNAL OF NEUROTRAUMA 2010. [DOI: 10.1016/s0973-0508(10)80033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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CT and MR imaging of primary cerebrovascular complications in pediatric head trauma. Emerg Radiol 2010; 17:309-15. [DOI: 10.1007/s10140-010-0860-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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11
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Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemelä M, Hernesniemi J. Distal Anterior Cerebral Artery Aneurysms. SURGICAL MANAGEMENT OF CEREBROVASCULAR DISEASE 2010; 107:15-26. [DOI: 10.1007/978-3-211-99373-6_3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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12
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Koh JS, Kim GK, Kim EJ, Lim YJ, Rhee BA, Kim TS. Serial Angiographic Evolution and Regression of Traumatic Aneurysm of the Internal Carotid Artery Associated With a Carotid-Cavernous Fistula. ACTA ACUST UNITED AC 2008; 64:E76-80. [PMID: 17514034 DOI: 10.1097/01.ta.0000203580.39746.cf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jun-Seok Koh
- Departments of Neurosurgery, Hospital of Kyung-Hee University College of Medicine, Seoul, Korea.
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13
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Wang CH, Lee HC, Cho DY. Traumatic pseudoaneurysm of the middle meningeal artery: possible indicators for early diagnosis in the computed tomography era. ACTA ACUST UNITED AC 2008; 68:676-681. [PMID: 18053868 DOI: 10.1016/j.surneu.2006.11.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Accepted: 11/13/2006] [Indexed: 10/22/2022]
Abstract
OBJECTIVE AND IMPORTANCE Traumatic pseudoaneurysms of the middle meningeal artery, which are associated with high mortality, are difficult to detect early by CT. We provide serial CT scans to show the steps of their formation and suggest characteristics that could be useful in the detection. CLINICAL PRESENTATION A 25-year-old man was initially in deep coma had an anisocoric pupil after a traffic accident. Brain CT showed basal skull fracture and traumatic subarachnoid hemorrhage with severe brain swelling. Emergent decompressive craniectomy was performed, and 2 days later, an EDH appeared at the left temporal fossa. Careful examination of the image revealed a hypodense nodule inside the acute hematoma. He underwent craniotomy to remove the hematoma. Serial CT of the residual hematoma showed the gradual development of an organized hematoma around the hypodense nodule. The nodule had low density, which was strongly enhanced on CT after injection of contrast medium. The nodule was highly suspected to be a vascular lesion. A middle meningeal artery pseudoaneurysm was discovered through a 3-dimensional computed tomographic angiography. He underwent another craniotomy to remove the pseudoaneurysm. INTERVENTION The diagnostic approach was CT, 3-dimensional CT, and craniotomies. CONCLUSION Four CT findings may be useful for early diagnosis: (1) basal skull fracture in the temporal region; (2) hypodense nodule within an acute hematoma; (3) hypodense nodule within an organized and encapsulated hematoma; and (4) strong and homogenous enhancement of the hypodense nodule within an organized and encapsulated hematoma. Three-dimensional computed tomographic angiography is an effective and noninvasive tool to confirm this diagnosis.
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Affiliation(s)
- Chih-Hsiu Wang
- Department of Neurosurgery, China Medical University Hospital, Taichung 404, ROC Taiwan
| | - Hang-Chung Lee
- Department of Neurosurgery, China Medical University Hospital, Taichung 404, ROC Taiwan.
| | - Der-Yang Cho
- Department of Neurosurgery, China Medical University Hospital, Taichung 404, ROC Taiwan
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14
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Posters. Interv Neuroradiol 2007. [DOI: 10.1177/15910199070130s210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Horiuchi T, Nakagawa F, Miyatake M, Iwashita T, Tanaka Y, Hongo K. Traumatic middle cerebral artery aneurysm: case report and review of the literature. Neurosurg Rev 2007; 30:263-7; discussion 267. [PMID: 17440757 DOI: 10.1007/s10143-007-0073-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
Traumatic intracranial aneurysms are rare. A case of traumatic middle cerebral artery aneurysm was presented. A 66-year-old man sustained a severe head injury in a bicycle accident. Serial computed tomography and angiography showed the delayed intracerebral hemorrhage caused by the traumatic middle cerebral artery aneurysm. The aneurysm was trapped and removed. Histological examination clearly revealed the pseudoaneurysm. Traumatic middle cerebral aneurysms were reviewed.
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16
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Chibbaro S, Tacconi L. Orbito-cranial injuries caused by penetrating non-missile foreign bodies. Experience with eighteen patients. Acta Neurochir (Wien) 2006; 148:937-41; discussion 941-2. [PMID: 16763734 DOI: 10.1007/s00701-006-0794-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Penetrating non-missile orbito-cranial injuries are uncommon civilian injuries which have some special features. Only limited case-reports are available in the international literature. METHOD We present a retrospective review of 18 such in presumed trivial orbital injury. Early identification and removal of retained foreign body fragments was achieved within 36 hours. FINDINGS Patients were operated on and followed up for at least of 3 years. The final clinical outcome was excellent: 16 had a Glasgow Outcome Scale (GOS) of 5 while in the remaining 2 it was 4. CONCLUSION The present report indicates that good results, in managing such injuries, can be achieved by a high index of suspicion and early diagnosis of intracranial injury in presumed trivial wounds and by the removal of every possible retained foreign body.
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MESH Headings
- Adolescent
- Adult
- Anti-Bacterial Agents/therapeutic use
- Brain Abscess/etiology
- Brain Abscess/surgery
- Brain Injuries/diagnosis
- Brain Injuries/etiology
- Brain Injuries/physiopathology
- Cerebral Hemorrhage, Traumatic/etiology
- Cerebral Hemorrhage, Traumatic/surgery
- Cranial Fossa, Anterior/diagnostic imaging
- Cranial Fossa, Anterior/injuries
- Cranial Fossa, Anterior/pathology
- Diagnosis, Differential
- Early Diagnosis
- Eye Infections/etiology
- Eye Infections/prevention & control
- Female
- Foreign Bodies/complications
- Foreign Bodies/diagnosis
- Foreign Bodies/physiopathology
- Frontal Bone/diagnostic imaging
- Frontal Bone/injuries
- Frontal Bone/pathology
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnosis
- Head Injuries, Penetrating/physiopathology
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neurosurgical Procedures/methods
- Neurosurgical Procedures/standards
- Orbital Fractures/complications
- Orbital Fractures/diagnosis
- Orbital Fractures/physiopathology
- Predictive Value of Tests
- Retrospective Studies
- Tomography, X-Ray Computed
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, Trieste University Hospital, Trieste, Italy.
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17
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Lee CY, Yim MB, Benndorf G. Traumatic pseudoaneurysm of the pharyngeal artery: An unusual cause of hematemesis and hematochezia after craniofacial trauma. ACTA ACUST UNITED AC 2006; 66:444-6; discussion 446. [PMID: 17015139 DOI: 10.1016/j.surneu.2005.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2005] [Accepted: 12/08/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Traumatic aneurysms of the internal maxillary artery are extremely rare. We report a case of traumatic pseudoaneurysm of the pharyngeal artery, a branch of the internal maxillary artery, presenting with hematemesis and hematochezia. CASE DESCRIPTION An 18-year-old man presented with deep drowsy consciousness after a motor vehicle accident, in which he had a severe craniofacial injury. Three days later, he had hematemesis and hematochezia with a marked decrease in circulating hemoglobin level. External carotid arteriography performed to rule out vascular injury revealed active leakage from a false aneurysm of the pharyngeal artery. The lesion was successfully obliterated by superselective endovascular embolization. CONCLUSIONS In patients with craniofacial injury associated with multiple traumas, traumatic pseudoaneurysm of the pharyngeal artery should be suspected as one of the possible causes of hematemesis and hematochezia. Selective endovascular embolization with cerebral angiography is an effective modality for the treatment and diagnosis of this lesion.
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Affiliation(s)
- Chang-Young Lee
- Department of Neurosurgery, Keimyung University School of Medicine, Daegu 700-712, South Korea.
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18
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Marx MV, Tam A, Teitelbaum G. SIR 2005 Annual Meeting Film Panel Case: Traumatic Pericallosal Pseudoaneurysm. J Vasc Interv Radiol 2005; 16:631-4. [PMID: 15872316 DOI: 10.1016/s1051-0443(07)60643-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M Victoria Marx
- Department of Radiology, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA.
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19
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Jabre A, Lewis MS, Sakai O. Radiological Evaluation of Cerebral Aneurysms in Selected Clinical Presentations. J Neuroimaging 2005. [DOI: 10.1111/j.1552-6569.2005.tb00280.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Mori K, Kasuga C, Nakao Y, Yamamoto T, Maeda M. Intracranial pseudoaneurysm due to rupture of a saccular aneurysm mimicking a large partially thrombosed aneurysm ("ghost aneurysm"): radiological findings and therapeutic implications in two cases. Neurosurg Rev 2004; 27:289-93. [PMID: 15108050 DOI: 10.1007/s10143-004-0336-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2004] [Accepted: 03/23/2004] [Indexed: 11/25/2022]
Abstract
Intracranial pseudoaneurysm formation due to ruptured non-traumatic saccular aneurysm is extremely rare. We experienced two cases of large pseudoaneurysm formation due to rupture of a saccular aneurysm. The neuroradiological ghost-like appearance of the aneurysms led to misdiagnoses as large partially thrombosed aneurysm. Two cases of large intracranial pseudoaneurysm formation due to rupture of a saccular aneurysm occurred in a 77-year-old comatose woman with an aneurysm on the anterior wall of the internal carotid artery and a 73-year-old comatose woman with an anterior cerebral artery (azygos) aneurysm. Both patients suffered subarachnoid hemorrhage associated with intracerebral and intraventricular hematomas. Angiography showed peculiar "ghost-like" appearance of the aneurysm including delayed filling, changing shape, retention of the contrast material after the venous phase, and unclear location of neck. Neck clipping surgeries were performed, but were difficult because of the preoperative misdiagnosis as large partially thrombosed aneurysm. The entity of "ghost aneurysm" caused by rupture of a saccular aneurysm should be considered in the clinical diagnosis.
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Affiliation(s)
- Kentaro Mori
- Department of Neurosurgery, Izunagaoka Hospital, Juntendo University, 1129 Nagaoka, Izunagaoka-cho, Tagata-gun, Shizuoka, Japan.
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21
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Lee CY, Yim MB, Kim IM, Son EI, Kim DW. Traumatic aneurysm of the supraclinoid internal carotid artery and an associated carotid—cavernous fistula: vascular reconstruction performed using intravascular implantation of stents and coils. J Neurosurg 2004; 100:115-9. [PMID: 14743921 DOI: 10.3171/jns.2004.100.1.0115] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ This report documents the treatment of a traumatic aneurysm of the supraclinoid internal carotid artery (ICA) that was associated with a carotid—cavernous fistula (CCF), which appeared following closed head trauma. This life-threatening lesion, which is very rare, required aggressive management achieved using intravascular stents and coils. A 19-year-old man presented with severe traumatic intracerebral and subarachnoid hematoma after he had suffered a severe closed head injury in a motor vehicle accident. Cerebral angiography performed 11 days after the injury demonstrated a traumatic aneurysm and severe narrowing of the right supraclinoid ICA, which was consistent with a dissection-induced stenosis associated with a direct CCF. Both lesions were successfully obliterated with preservation of the parent artery by using stents in conjunction with coils. Follow-up angiography obtained 7 months postoperatively revealed persistent obliteration of the aneurysm and CCF as well as patency of the parent artery. The patient remained asymptomatic during the clinical follow-up period of 14 months. Endovascular treatment involving the use of a stent combined with coils appears to be a feasible, minimally invasive option for treatment of this hard-to-treat lesion.
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Affiliation(s)
- Chang-Young Lee
- Department of Neurosurgery, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea
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22
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Cunningham LL, Van Sickels J, Brandt MT. Angiographic evaluation of the head and neck. Atlas Oral Maxillofac Surg Clin North Am 2003; 11:73-86. [PMID: 12725100 DOI: 10.1016/s1061-3315(02)00008-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Larry L Cunningham
- Division of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, 800 Rose Street, Room D-508, Lexington, KY 40536-0297, USA.
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23
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Nanda A, Vannemreddy PSSV, Willis BK, Baskaya MK, Jawahar A. Management of carotid artery injuries: Louisiana State University Shreveport experience. SURGICAL NEUROLOGY 2003; 59:184-90; discussion 190. [PMID: 12681549 DOI: 10.1016/s0090-3019(03)00021-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic carotid artery injury is an infrequently encountered surgical entity. Carotid artery injuries in polytrauma patients can be easily missed in the absence of clinical findings and/or presence of confounding concurrent injuries. METHODS Between 1991 and 1998, 23 patients were diagnosed with various carotid artery injuries at the trauma center of Louisiana State University Health Sciences Center, Shreveport, Louisiana. Injuries were assessed by angiography and/or surgical exploration of the neck. Clinical presentations, radiologic features, management strategies, and neurologic outcomes were statistically analyzed and compared with the existing literature. RESULTS Twelve patients (52%) had penetrating carotid artery injuries, while 11 (48%) had blunt trauma. The diagnosis of carotid injury was significantly delayed in the group with blunt trauma as opposed to those with penetrating wounds. Surgical repair was performed in 6 (26%) patients; 2 (8%) underwent balloon occlusion, while ligation was conducted in 2 (8%) patients. Thirteen patients (57%) were treated conservatively with anticoagulants. Six patients (26%) died, while another 6 (26%) had permanent neurologic deficit. Mortality and morbidity was significantly higher in the group with penetrating injuries. A statistical analysis showed that multi-level carotid injury (p < 0.002) and increasing age (p < 0.001) had a significantly higher mortality. CONCLUSIONS Injury to carotid arteries results in significant mortality and morbidity. Our results indicate that penetrating carotid injury at more than one level carries higher mortality and morbidity rates than blunt injury. Furthermore, early identification of the injured segment may favorably influence the outcome for such patients.
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Affiliation(s)
- Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, 1501 Kings Highway, PO Box 33932, Shreveport, LA 71130-3932, USA
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Murakami M, Kakita K, Hosokawa Y. Ruptured traumatic aneurysm after trivial injury mimicking acute spontaneous subdural hematoma--case report-. Neurol Med Chir (Tokyo) 2003; 43:130-3. [PMID: 12699120 DOI: 10.2176/nmc.43.130] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 75-year-old man suffered acute subdural hematoma shortly after trivial head trauma. Thirteen hours after a trivial brow to the occipital region, caused by contact with a mat, he suddenly deteriorated to the level of a Glasgow Coma Scale score of 6. Computed tomography demonstrated an acute subdural hematoma on the left and angiography revealed an aneurysm of the distal middle cerebral artery. An emergent craniotomy disclosed no skull fracture and exposed a thick subdural hematoma with no brain contusions. After evacuation of the hematoma, an aneurysm was found on the distal portion of posterior temporal artery, which was compatible with the angiographical findings. The neck of aneurysm was so fragile that neck clipping could not be successfully performed. Therefore, the aneurysm was extirpated, and the bleeding site coagulated with oxidized cellulose reinforcement. Histological examination of the aneurysm indicated a pseudoaneurysm during the early phase of clot formation. The acute subdural hematoma resulted from rupture of this pseudoaneurysm which was formed shortly after the minor head trauma. Rupture of a pseudoaneurysm caused by trivial trauma might be one of the origins for so-called acute "spontaneous" subdural hematoma.
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Affiliation(s)
- Mamoru Murakami
- Department of Neurosurgery, Kyoto First Red Cross Hospital, Kyoto, Japan.
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25
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Abstract
Traumatic vascular injury to the intracranial and extracranial circulation can be sequelae of blunt, penetrating, or iatrogenic insults to the head, face, or neck. Treatment options include conservative medical management, or more invasive surgical or endovascular therapy. The appropriate treatment depends on the risk-benefit ratio of each option considering the natural history of each. Injuries include mild intimal irregularities, intimal flaps, pseudoaneurysms, fistulas, and occlusions. Need for treatment is partly determined by the collateral circulation to the brain, and the degree to which the lesion is thrombogenic. Advances in endovascular devices and techniques provide us with less invasive alternatives to surgery intervention or allow the interventionalist to treat lesions not treatable by any other modality.
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Affiliation(s)
- Donald W Larsen
- Department of Neurological Surgery and Radiology, Keck School of Medicine, University of Southern California, Department of Interventional Neuroradiology, University of Southern California Medical Center, Los Angeles, CA, USA.
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Komiyama M, Morikawa T, Nakajima H, Yasui T, Kan M. "Early" apoplexy due to traumatic intracranial aneurysm--case report. Neurol Med Chir (Tokyo) 2001; 41:264-70. [PMID: 11396307 DOI: 10.2176/nmc.41.264] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 76-year-old man presented with a traumatic aneurysm of the left internal carotid artery which caused repeated subarachnoid hemorrhages within 20 hours of a fall from a height. Early computed tomography (CT) detected no brain abnormalities, but repeat CT found subarachnoid hemorrhage. Internal carotid angiography detected a pseudoaneurysm, which was not treated because of his poor clinical condition. He died of multiple organ failure. Early detection of a traumatic intracranial aneurysm is important for the prevention of aneurysmal rupture, or "delayed" apoplexy. Review of 171 cases with traumatic aneurysms from the literature found that false negative angiography occurred only in three cases on post-trauma day 7 and thereafter. Early diagnostic angiography within a week of the initial trauma is indicated if traumatic aneurysm is suspected to detect early signs of irregularity, spasm, and narrowing of the arterial wall. Repeat angiography is indicated if aneurysmal formation is still highly suspected in spite of negative initial angiography.
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Affiliation(s)
- M Komiyama
- Department of Neurosurgery, Osaka City General Hospital, Osaka
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28
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Abstract
Cerebrovascular trauma includes a wide variety of injuries, including dissections, traumatic aneurysms, arteriovenous fistulas, and vascular occlusions. These entities, which are often underdiagnosed, can produce devastating neurologic complications. This article reviews the clinical and radiographic presentations of vascular trauma to increase awareness of these injuries and improve our ability to detect and treat them.
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Affiliation(s)
- M F Gaskill-Shipley
- Department of Radiology, University of Cincinnati College of Medicine, The University Hospital, OH 45267-0762, USA.
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29
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Abstract
Traumatic intracranial aneurysms are rare, occurring in fewer than 1% of patients with cerebral aneurysms. They can occur following blunt or penetrating head trauma and are more common in the pediatric population. Traumatic aneurysms can be categorized histologically as true, false, or mixed, with false aneurysms being the most common. These aneurysms can present in a variety of ways, but are typically associated with an acute episode of delayed intracranial hemorrhage with an average time from initial trauma to aneurysm hemorrhage of approximately 21 days. The mortality rate for patients harboring these aneurysms may be as high as 50%. Prompt diagnosis based on arteriography and aggressive surgical management are associated with better outcome than conservative treatment. The authors describe a classification scheme for traumatic aneurysms based on their anatomical location and conclude that 1) post-traumatic aneurysm must be considered in patients with acute neurological deterioration following closed head injury; 2) they can occur following mild closed head injury; 3) they occur more commonly in children than in adults; and 4) surgical clipping and/or endovascular occlusion is the definitive treatment.
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Affiliation(s)
- P S Larson
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
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30
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Hemphill JC, Gress DR, Halbach VV. Endovascular therapy of traumatic injuries of the intracranial cerebral arteries. Crit Care Clin 1999; 15:811-29. [PMID: 10569123 DOI: 10.1016/s0749-0704(05)70089-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Traumatic intracranial arterial injuries represent uncommon complications of both closed-head injury and penetrating head trauma. These injuries include arterial dissections, pseudoaneurysms, and fistulas, both direct and indirect. Although these lesions may be identified while still asymptomatic, they usually present in a delayed fashion with intracranial hemorrhage, focal cerebral ischemia, or, occasionally, severe epistaxis. Endovascular therapy has assumed a major role in the management of this diverse group of lesions. Embolization of pseudoaneurysms with balloons or detachable coils, the use of embolic particles for small arterial injuries, and large vessel occlusion with detachable balloons represent current treatment strategies that have evolved over the past three decades. Angioplasty and stent deployment may have a future role to play in the management of arterial dissection. Principles of neurologic critical care that minimize secondary brain injury are essential adjuncts in the management of these patients before, during, and after endovascular treatment.
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Affiliation(s)
- J C Hemphill
- Department of Neurology, University of California, San Francisco, USA
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31
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Horowitz MB, Kopitnik TA, Landreneau F, Ramnani DM, Rushing EJ, George E, Purdy PP, Samson DS. Multidisciplinary approach to traumatic intracranial aneurysms secondary to shotgun and handgun wounds. SURGICAL NEUROLOGY 1999; 51:31-41; discussion 41-2. [PMID: 9952121 DOI: 10.1016/s0090-3019(98)00029-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) may develop following gunshot injuries to the head. Management of these lesions often combines various aspects of microneurosurgical and endovascular techniques to safely repair or obliterate vessel defects. METHODS We reviewed our experience over the last 18 years and identified five cases of intracranial aneurysms following gunshot and handgun wounds that were treated surgically and/or endovascularly. RESULTS All patients had successful obliteration of their lesions using a variety of therapeutic modalities aimed at preserving neurologic function while at the same time eliminating the aneurysm from the circulation. CONCLUSION Both microneurosurgery and endovascular surgery have important roles to play in the management of TICAs. In some cases, both methods can be combined to eliminate lesions and maximize patient recovery in a safe, efficient, and effective fashion.
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Affiliation(s)
- M B Horowitz
- Department of Neurosurgery, University of Texas Southwestern Medical Center at Dallas, 75235-8855, USA
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32
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Inci S, Erbengi A, Ozgen T. Aneurysms of the distal anterior cerebral artery: report of 14 cases and a review of the literature. SURGICAL NEUROLOGY 1998; 50:130-9; discussion 139-40. [PMID: 9701118 DOI: 10.1016/s0090-3019(97)00344-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Distal anterior cerebral artery aneurysms are rare and compose about 4.5% of all intracranial aneurysms. They generally arise at the bifurcation of the pericallosal and callosomarginal arteries. Their surgical approach is different from those of other anterior circulation aneurysms. These aneurysms present some special difficulties for neurosurgeons, including narrow exposure in the interhemispheric fissure, dense adhesions between the cingulate gyri, difficulty in controlling the parent artery, and the association of multiple aneurysms and vascular anomalies. METHODS Between January 1975 and May 1996, 14 cases of saccular aneurysms of the distal anterior cerebral artery were operated at the University of Hacettepe. The clinical presentations, neuroradiological findings, and operative approaches of these aneurysms were analyzed. In addition, the clinical series and isolated case reports in the English literature were also extensively reviewed. RESULTS The incidence of the aneurysms in this location was 2.8% of a total of 494 surgically treated cases in our center. Of 14 patients, eight were women and six were men. Multiple aneurysms were found in five patients (35%). All patients were operated via the interhemispheric route. Thirteen patients had good outcome and one patient died. CONCLUSIONS We believe that all difficulties related to distal anterior cerebral artery aneurysms can be minimized with sufficient knowledge of microsurgery and surgical anatomy, using microtechniques and experience.
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Affiliation(s)
- S Inci
- Hacettepe University, Medical School, Department of Neurosurgery, Ankara, Turkey
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33
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Pedrosa M, del Pozo J, Vaquero J. Aneurisma cerebral traumático secundario a la resección de meningioma intracraneal. Neurocirugia (Astur) 1998. [DOI: 10.1016/s1130-1473(98)71024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Proust F, Callonec F, Bellow F, Laquerriere A, Hannequin D, Fréger P. Tentorial edge traumatic aneurysm of the superior cerebellar artery. Case report. J Neurosurg 1997; 87:950-4. [PMID: 9384410 DOI: 10.3171/jns.1997.87.6.0950] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors report an unusual case of a traumatic aneurysm of the right superior cerebellar artery (SCA). A 22-year-old woman presented with continuous headaches that appeared 15 days after she experienced closed head trauma as a result of a cycling accident. Computerized tomography scanning performed 3 months later showed a nodular lesion on the free edge of the tentorium, which mimicked a meningioma. The aneurysm was identified on magnetic resonance angiography, which showed the SCA as the parent vessel. The parent vessel was trapped, and the aneurysm sac was excised via right temporal craniotomy. Pathological examination of the sac revealed a false aneurysm. The patient's outcome was excellent. The pathophysiology of traumatic aneurysm at such a location suggests that surgery may be the treatment of choice.
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Affiliation(s)
- F Proust
- Federation of Neurosciences and Department of Pathology, Centre Hospitalo-Universitaire Charles Nicolle, Rouen, France
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35
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Amirjamshidi A, Rahmat H, Abbassioun K. Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and management. A survey of 31 cases and review of the literature. J Neurosurg 1996; 84:769-80. [PMID: 8622150 DOI: 10.3171/jns.1996.84.5.0769] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the early days of the war between Iran and Iraq, reports of the sudden deaths of soldiers who previously had survived a penetrating head injury suggested the possibility that a late complication, traumatic aneurysm (TA), could be the cause of this catastrophe. In response, the authors planned a prospective study to perform cerebral angiography in victims with penetrating head traumas, especially in those who had artillery shells or bone fragments passing through areas of dense vasculature. Thirty-one TAs and arteriovenous fistulas were documented. Not all of the lesions, however, were deemed appropriate for surgical intervention. Six aneurysms (19.4%) healed spontaneously and shrank or disappeared on repeated serial angiograms. The authors present their cases and discuss the incidence of TAs, their natural course and behavior, and the special problems encountered in managing these interesting and potentially fatal complications of penetrating head injuries.
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Affiliation(s)
- A Amirjamshidi
- Sina Hospital, Tehran University of Medical Sciences, Iran
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36
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Gómez Sierra A, Rodríguez de Lope A, Carrera J, Pérez Calvo J, Carrillo Yague R. Aneurismas intracraneales traumáticos. Neurocirugia (Astur) 1996. [DOI: 10.1016/s1130-1473(96)70747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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37
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George ED, Dagi TF. Military Penetrating Craniocerebral Injuries: Applications to Civilian Triage and Management. Neurosurg Clin N Am 1995. [DOI: 10.1016/s1042-3680(18)30430-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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39
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Ventureyra EC, Higgins MJ. Traumatic intracranial aneurysms in childhood and adolescence. Case reports and review of the literature. Childs Nerv Syst 1994; 10:361-79. [PMID: 7842423 DOI: 10.1007/bf00335125] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report four pediatric traumatic intracranial aneurysms occurring before the age of 10 years. Two of these aneurysms were the result of closed head injury. The remaining two were iatrogenic aneurysms which occurred in unusual circumstances. These four children represent 33% of the pediatric intracranial aneurysms seen at the Children's Hospital of Eastern Ontario from 1974 to 1992. Diagnosis of traumatic intracranial aneurysms requires a high index of suspicion: any head-injured or postoperative child who experiences delayed neurologic deterioration, or who fails to improve as expected following treatment, should promptly undergo diagnostic intracranial imaging. Documented subarachnoid hemorrhage, intracerebral or intraventricular hemorrhage, or subdural haematoma in this clinical setting should be further investigated by cerebral angiography to exclude a traumatic aneurysm or other vascular lesion. Traumatic aneurysms typically arise at the skull base or from distal anterior or middle cerebral arteries or branches consequent to direct mural injury or to acceleration-induced shear. Reported traumatic aneurysms account for 14%-39% of all pediatric aneurysms. Iatrogenic aneurysms also occur with unexpected frequency during childhood and adolescence. Pediatric traumatic cerebral aneurysms may present early or late. Most present early with intracranial hemorrhage. Late presentation occurs infrequently, typically as an aneurysmal mass. Once diagnosed, these aneurysms should be promptly treated by craniotomy employing routine microsurgical techniques, or in some cases, by endovascular detachable balloon techniques. Delay in operative treatment entails significant risks of repeated hemorrhage and death. Outcome in these children is primarily determined by the extent of traumatic cerebral injury and the preoperative clinical status. The latter directly depends upon diagnosis of the aneurysm prior to either initial or repeated hemorrhage.
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Affiliation(s)
- E C Ventureyra
- Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada
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40
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Casey AT, Moore AJ. A traumatic giant posterior cerebral artery aneurysm mimicking a tentorial edge meningioma. Br J Neurosurg 1994; 8:97-9. [PMID: 8011203 DOI: 10.3109/02688699409002401] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Traumatic intracranial aneurysms due to non-penetrating trauma are rare. Commonly they are associated with an overlying fracture or secondary to trauma against the falcine edge in the case of the distal anterior cerebral artery. To date, only one case of traumatic posterior cerebral artery aneurysm has been reported associated with a comminuted depressed occipital fracture and lacerated transverse sinus. We report a case of a giant traumatic aneurysm of the posterior cerebral artery P2 branch directly associated with the tentorial edge. Its mechanism of formation is analogous to the falcine distal anterior cerebral artery aneurysms.
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Affiliation(s)
- A T Casey
- Department of Neurosurgery, Atkinson Morley's Hospital, Wimbledon, London, UK
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41
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Levy ML, Rezai A, Masri LS, Litofsky SN, Giannotta SL, Apuzzo ML, Weiss MH. The significance of subarachnoid hemorrhage after penetrating craniocerebral injury: correlations with angiography and outcome in a civilian population. Neurosurgery 1993; 32:532-40. [PMID: 8474643 DOI: 10.1227/00006123-199304000-00007] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Certain clinical factors are considered to have an effect on patient outcome after penetrating missile injury. These include bilateral hemispheric injury, ventricular hemorrhage, intracerebral hemorrhage, mass effect, and missile or bony fragmentation. The relationship of subarachnoid hemorrhage (SAH) after penetrating craniocerebral injury and outcome is unknown. In addition, controversy exists regarding the role of angiography and the incidence of traumatic intracranial aneurysm in this population. Finally, can we assume that the incidence of traumatic intracranial aneurysm is equal in military and civilian populations, given the absence of penetrating shrapnel injury in civilian populations? Now that computed tomography has supplanted angiography as the primary diagnostic modality, increasing vigilance on the part of the physician and examination of angiography in high-risk patients should allow for enhanced outcome. We evaluated 100 patients with a diagnosis of cerebral gunshot wound over a 12-month period. All patients were evaluated neurologically at the time of admission and had imaging studies. Thirty-one patients with radiological evidence of SAH on computed tomography underwent angiography. Angiograms were limited to the side of the injury in patients with single-lobe or unilateral multilobe injuries and were bilateral in patients with bilateral hemispheric involvement. One intracranial aneurysm (3.2%) was documented and treated surgically. In those patients who died within 48 hours of admission, 68% had SAH as compared with only 17% of those surviving. Outcome was based upon neurological evaluation at the time of discharge and at the time of clinical follow-up at 3 and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M L Levy
- Department of Neurological Surgery, University of Southern California School of Medicine, Los Angeles
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44
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du Trevou MD, van Dellen JR. Penetrating stab wounds to the brain: the timing of angiography in patients presenting with the weapon already removed. Neurosurgery 1992; 31:905-11; discussion 911-2. [PMID: 1436415 DOI: 10.1227/00006123-199211000-00012] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Angiography is always necessary in patients with penetrating stab wounds to the head, to exclude unexpected vascular lesions. The most important, since they are seldom clinically evident, are traumatic aneurysms and arteriovenous fistulae. It has previously been proposed that carotid angiography should be delayed until the start of the second week, to allow for better visualization of these complications. However, traumatic aneurysms can rupture at any time after the injury, and the mortality resulting from a second hemorrhage is unacceptably high. A prospective study was undertaken in which 330 patients with penetrating stab wounds to the head underwent angiography as soon as possible after admission. In 250 of these patients (76%), the weapon had already been removed by the assailant, and there was radiological evidence of penetration of the dura. Of these 250, 130 patients underwent angiography within 7 days of the injury. Another 51 patients, who presented late, underwent angiography more than 7 days after the injury. The timing of angiography did not affect the identification of traumatic aneurysms, the incidence of which was 12% in both groups. Of the patients with cranial stabs and who required urgent evacuation of intracerebral hematomas, 10% had traumatic aneurysms that could be dealt with simultaneously. No patient in this series suffered a secondary hemorrhage. We conclude that it is neither necessary nor safe to delay angiography. In some patients, either because of vasospasm or "cut-off" of a vessel, a second angiogram may be necessary to further elucidate a vascular abnormality that might not have been evident originally.
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Affiliation(s)
- M D du Trevou
- Department of Neurosurgery, University of Natal Faculty of Medicine, Durban, South Africa
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45
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Masana Y, Taneda M. Direct approach to a traumatic giant internal carotid artery aneurysm associated with a carotid-cavernous fistula. Case report. J Neurosurg 1992; 76:524-7. [PMID: 1738034 DOI: 10.3171/jns.1992.76.3.0524] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The case is reported of a giant intracranial internal carotid artery aneurysm associated with a carotid-cavernous fistula following a closed head injury. The aneurysm and the fistula disappeared after only the neck of the aneurysm was clipped. This is the first case in which a direct surgical approach was successful in sparing the internal carotid flow. Reports of similar cases are reviewed.
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Affiliation(s)
- Y Masana
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan
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46
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Abstract
The case of a young woman who developed a traumatic distal anterior cerebral artery ("pericallosal") aneurysm from a roller-coaster ride is described. She presented with a subarachnoid hemorrhage (SAH) restricted to the interhemispheric fissure. The initial angiogram was normal but repeat angiography at 8 days revealed the aneurysm. After craniotomy and clipping the patient made a satisfactory recovery. This is the only reported case of a traumatic aneurysm arising under circumstances not usually considered as trauma. It raises questions about the pathophysiology of the formation of such aneurysms and suggests that traumatic pericallosal aneurysms should be considered in SAH of unknown etiology. This case provides further evidence that repeat angiography occasionally helps reveal an aneurysm when the initial study fails to do so.
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Affiliation(s)
- M Senegor
- Neurological Surgery Associates of Cincinnati, Ohio
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47
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du Trevou M, Bullock R, Teasdale E, Quin RO. False aneurysms of the carotid tree due to unsuspected penetrating injury of the head and neck. Injury 1991; 22:237-9. [PMID: 2071213 DOI: 10.1016/0020-1383(91)90053-h] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M du Trevou
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
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48
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Hahn YS, Welling B, Reichman OH, Azar-Kia B. Traumatic intracavernous aneurysm in children: massive epistaxis without ophthalmic signs. Childs Nerv Syst 1990; 6:360-4. [PMID: 2257552 DOI: 10.1007/bf00298285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Traumatic intracavernous aneurysms are a distinctly uncommon lesion in children. They usually present with compressive symptoms of the III, IV, V, or VI cranial nerves rather than epistaxis. Epistaxis is rare and usually minor and brief in duration. A child with severe head injury and basal skull fracture, who did not have any preceding symptoms or signs of ophthalmoplegia or exophthalmus, developed massive epistaxis as a leading symptom of the ruptured intracavernous aneurysm. Since there are no reported pediatric cases with fatal epistaxis as a presenting sign, we would like to share our experience.
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Affiliation(s)
- Y S Hahn
- Department of Pediatric Neurosurgery, Loyola University Medical Center, Maywood, IL 60153
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49
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Abstract
The authors report a case of giant traumatic true aneurysm of the middle cerebral artery. A review of the related literature and a general revision are presented.
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Affiliation(s)
- M Gelabert
- Department of Surgery, Hospital General de Galicia, Santiago de Compostela, Spain
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50
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Soria ED, Paroski MW, Schamann ME. Traumatic aneurysms of cerebral vessels: a case study and review of the literature. Angiology 1988; 39:609-15. [PMID: 3044196 DOI: 10.1177/000331978803900708] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Traumatic cerebral aneurysms (TCAs) are rare: few more than 100 cases are recorded in the world literature. TCAs are located predominantly in the supratentorial compartment and are classified as either "true" or "false." A true aneurysm is a dilation resulting from partial disruption of the arterial wall. A false aneurysm results from a full-thickness tear, with the scar from the brain tissue or an organized hematoma acting as the aneurysmal wall. The authors present a case of a false traumatic aneurysm of the pericallosal artery, which was discovered in a young patient fourteen months after a self-inflicted gunshot wound to his head. The aneurysm was an incidental finding on a CT scan performed for the investigation of his late posttraumatic seizures. Its presence was confirmed by angiography. The interval between the traumatic episode and the diagnosis of a TCA usually ranges from a few hours to a few weeks, for most are discovered by angiography performed in the acute or subacute stage of a head injury. The long interval between the injury and the diagnosis in our case is exceptional. A previous CT scan done four months after the injury did not reveal the aneurysm, which strongly suggests a protracted growth of the aneurysmal sac long after the trauma.
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Affiliation(s)
- E D Soria
- SUNY at Buffalo, School of Medicine, V.A. Medical Center
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