创伤性颅底动脉损伤的临床特征及规范化治疗

Clinical features and standard treatment of traumatic basicranial artery injury

目的探讨创伤性颅底动脉损伤的临床特征及诊疗规范。方法回顾315例创伤性颅底动脉损伤患者的临床资料，按颅底动脉解剖部位和血管损伤的病理类型进行分类，根据患者全身状况、受累动脉的结构和血流动力学特点、脑组织血供改变以及侧支循环情况综合决定患者的治疗策略和方法，在此基础上分析显微外科手术、血管内治疗以及非手术治疗的临床预后，利用改良的Rankin评分（mRS）对患者进行随访，观察不同类型和不同治疗方法的患者预后情况。结果本组血管内治疗269例，显微外科手术18例，单纯非手术治疗28例。其中283例患者获得随访，时间3个月～15年，mRS0～2分269例，mRS3～5分11例，mRS6分（临床死亡）3例。结论规范的诊治流程是提高创伤性颅底动脉损伤救治成功率的关键。

Objective To summarize the clinical features of traumatic basicranial artery injury and standardize the diagnosis and treatment procedures. Methods Medical records of 315 consecutive patients diagnosed as traumatic basicranial artery injury were retrospectively reviewed. The patients were categorized according to the location and pathological subtypes of the injury. Treatment strategies were based on patients＇ general situation, structure of the involved arteries, hemodynamic characteristics, alterations of the cerebral blood supply and collateral circulation status. Then the patients were evaluated to help realizing the prognosis of microsurgery, intravascular treatment and conservative treatment respectively. The modified Rankin score （mRS） was used to measure the clinical outcome at follow-up. Results There were 269 patients managed with intravascular treatment, 18 microsurgery and 28 conservative treatment. A total of 283 patients were available to a follow-up of 3 months to 15 years, mRS was 0-2 in 283 patients, 3-5 in 11 patients and 6 in 3 patients. Conclusion Key to successful treatment of traumatic basicranial artery injury depends on standardized diagnosis and treatment procedures.