Traumatic Intracranial Carotid Tree Aneurysms

Traumatic Intracranial Carotid Tree Aneurysms AbstractOBJECTIVE:This study was designed to elucidate the requirements for an giographic evaluation in blunt head injuries, the timing of an giography, and the selection of appropriate the rapeutic approaches.METHODS:Twelve cases of traumatic aneurysms (TAs) in the intracranial carotid tree were analyzed in this study. Neurological examination results, computed tomographic scans, pre-and postembolization cerebral angiograms, and follow-up data were included.RESULTS:In 11 of 12 cases, TAs were of cranial base origin; in 1 case, the aneurysm was located in the distal anterior cerebral artery. In seven of the cases with cranial base lesions, aneurysms were located in the intracavernous segment of the internal carotid artery; all of the computed tomographic scans for these cases demonstrated sphenoid sinus wall fractures and hematoma in the sphenoid sinus. In two cases, although the initial angiograms revealed no lesions, a second study performed 2 weeks later demonstrated the presence of aneurysms. Nine of the aneurysms were treated with endovascular techniques, two were managed conservatively, and the remainingone patient died with massive epistaxis while awaiting surgical treatment. No morbidity or additional permanent neurological deficits occurred in the endovascularly treated patient group.CONCLUSION:Patients with head trauma who present with sphenoid sinus fractures and massive epistaxis should be evaluated for the development of TAs as soon as possible. If the patients exhibit fractures without epistaxis, an giography should be deferred for 2 to 3 weeks; if the first angiographic evaluation reveals normal findings, repeated epistaxis should prompt a second an giographic evaluation. Current treatment of TAs involves occlusion of the main artery through the use of endovascular techniques. Cases involving internal carotid artery TAs of cranial base origin and patients who do not tolerate test occlusion require extracranial-to-intracranial bypass surgery. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Traumatic Intracranial Carotid Tree Aneurysms

C L I N I C A L S T U D IE S Mustafa Uzan, M.D., Murat Cantasdemir, M.D., M. Sait Seckin, M.D., Murat H a n d , M .D., Naci Kocer, M.D., A. Cetin Sarioglu, M.D., Civan Islak, M.D. Departments of Neurosurgery (MU, MSS, MH, ACS) and Radiology (MC, NK, Cl), University of Istanbul, Cerrahpasa Medical Faculty, Istanbul, Turkey O B J E C T I V E : T h i s s t u d y w a s d e s ig n e d to e l u c i d a t e t h e r e q u ir e m e n t s f o r a n g i o g r a p h i c e v a l u a t i o n in b lu n t head i n ju r ie s , th e t i m i n g o f a n g i o g r a p h y , a n d t h e s e l e c t i o n o f a p p r o p r i a t e t h e r a p e u t i c a p p r o a c h e s . M E T H O D S : T w e l v e c a s e s o f t r a u m a t ic a n e u r y s m s ( T A s ) in t h e i n t r a c r a n i a l c a r o t i d t r e e w e r e a n a l y z e d in th is study. N e u r o l o g i c a l e x a m i n a t i o n r e s u lt s , c o m p u t e d t o m o g r a p h i c s c a n s , p r e - a n d p o s t e m b o l i z a t i o n c e r e b r a l angiogram s, a n d f o l l o w - u p d a t a w e r e i n c l u d e d . R E S U L T S : In 1 1 o f 1 2 c a s e s , T A s w e r e o f c r a n i a l b a s e o r i g i n ; in 1 c a s e , t h e a n e u r y s m w a s l o c a t e d in t h e d is t a l anterior c e r e b r a l a r t e r y . In s e v e n o f t h e c a s e s w it h c r a n i a l b a s e le s io n s , a n e u r y s m s w e r e lo c a t e d in t h e in tra ca v e rn o u s s e g m e n t o f th e in t e r n a l c a r o t id a r t e r y ; a ll o f th e c o m p u t e d t o m o g r a p h i c s c a n s f o r t h e s e c a s e s dem onstrated s p h e n o id s in u s w a l l f r a c t u r e s a n d h e m a t o m a in t h e s p h e n o id s in u s . In t w o c a s e s , a l t h o u g h t h e in it ia l angiogram s r e v e a le d n o le s io n s , a s e c o n d s t u d y p e r f o r m e d 2 w e e k s la t e r d e m o n s t r a t e d t h e p r e s e n c e o f a n e u r y s m s . Nine of th e a n e u r y s m s w e r e t r e...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199812000-00024
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVE:This study was designed to elucidate the requirements for an giographic evaluation in blunt head injuries, the timing of an giography, and the selection of appropriate the rapeutic approaches.METHODS:Twelve cases of traumatic aneurysms (TAs) in the intracranial carotid tree were analyzed in this study. Neurological examination results, computed tomographic scans, pre-and postembolization cerebral angiograms, and follow-up data were included.RESULTS:In 11 of 12 cases, TAs were of cranial base origin; in 1 case, the aneurysm was located in the distal anterior cerebral artery. In seven of the cases with cranial base lesions, aneurysms were located in the intracavernous segment of the internal carotid artery; all of the computed tomographic scans for these cases demonstrated sphenoid sinus wall fractures and hematoma in the sphenoid sinus. In two cases, although the initial angiograms revealed no lesions, a second study performed 2 weeks later demonstrated the presence of aneurysms. Nine of the aneurysms were treated with endovascular techniques, two were managed conservatively, and the remainingone patient died with massive epistaxis while awaiting surgical treatment. No morbidity or additional permanent neurological deficits occurred in the endovascularly treated patient group.CONCLUSION:Patients with head trauma who present with sphenoid sinus fractures and massive epistaxis should be evaluated for the development of TAs as soon as possible. If the patients exhibit fractures without epistaxis, an giography should be deferred for 2 to 3 weeks; if the first angiographic evaluation reveals normal findings, repeated epistaxis should prompt a second an giographic evaluation. Current treatment of TAs involves occlusion of the main artery through the use of endovascular techniques. Cases involving internal carotid artery TAs of cranial base origin and patients who do not tolerate test occlusion require extracranial-to-intracranial bypass surgery.

Journal

NeurosurgeryOxford University Press

Published: Dec 1, 1998

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