弹片穿透致重型颅脑损伤合并创伤性颅内动脉瘤1例及文献复习

Traumatic intracranial aneurysm in blast penetrating brain injury:1 case report and literature review

目的分析1例流弹爆炸伤致重型颅脑损伤合并创伤性颅内动脉瘤患者的救治经验并复习相关文献。方法2020年12月我科收治1例流弹爆炸致重型颅脑外伤患者,急诊行气管切开术+脑室外引流术,伤后第2天CTA检查发现左侧胼周动脉形成断端,约有2 mm的盲端增粗,未见假性动脉瘤瘤体、瘤腔形成;伤后第7天因脑水肿脑疝形成,行右侧开颅去骨瓣减压、伤道探查清创、坏死脑组织清除术;伤后第17天假性动脉瘤出血,经介入方法栓塞动脉瘤及载瘤动脉。结果患者伤后第44天恢复意识,可遵嘱闭眼伸指,3个月后格拉斯哥昏迷评分(GCS)15分,语言正常,拔除气管套管,正常进食,右侧肢体肌力5级,肌张力正常,左侧肢体偏瘫;临床随访12个月动脉瘤无复发出血。结论颅脑弹片穿透伤后脑水肿较重,需要早期减压手术;弹片穿透脑组织后会引起颅内假性动脉瘤,需要尽早筛查处理,避免发生迟发性大出血。

Objective To analyze our treatment experience of a case of traumatic intracranial aneurysm complicated with blast penetrating brain injury.Methods A case of traumatic brain injury(TBI)wounded by shrapnel was admitted in our department in December 2020.We performed emergency tracheostomy and external ventricular drainage.Computed tomography angiogram(CTA)on the second day after injury revealed a left-sided pericallosal artery forming stump with approximately 2 mm of blind end thickening,no pseudoaneurysm bodies,or aneurysm cavity formation.On the 7 th day,because of the refractory cerebral edema,we performed right side craniotomy and cleared the necrotic brain tissue.The pseudoaneurysm hemorrhaged on day 17 after injury,and the aneurysm and the parent artery were embolized by interventional methods.Results The patient regained consciousness on the 44 th day after injury and could follow instructions.Three months later he had a Glasgow coma scale(GCS)score of 15 with left limb hemiparesis.There were no recurrences of the aneurysm during 12 months of clinical follow-up.Conclusion Severe brain edema after penetrating shrapnel injuries often requires early decompression.Intracranial tarumatic aneurysms can arise after shrapnel penetrates,and require early screening management.