创伤性颅内动脉瘤的临床诊疗

Clinical diagnosis and treatment of traumatic intracranial aneurysms

创伤性颅内动脉瘤虽然不属于脑外伤的常见并发症,但发病隐匿的特点使其成为颅脑损伤患者延期死亡重要原因之一。创伤性颅内动脉瘤在伤后2~3周内破裂风险极高,可能在外伤后突发颅内出血、蛛网膜下腔出血或鼻、眼部大出血,所以怀疑创伤性动脉瘤的外伤患者需早期行颅内血管检查。创伤性颅内动脉瘤以假性动脉瘤为主,缺少完整的血管壁与瘤颈,其临床处理也与自发性动脉瘤有所不同。除了开颅手术治疗之外,单纯弹簧圈填塞、支架辅助弹簧圈栓塞、覆膜支架及血流导向装置等技术手段都已被学者应用于治疗创伤性颅内动脉瘤。本文针对创伤性颅内动脉瘤的危险因素、分类及发病机制、治疗手段做一综述,同时分享2例创伤性与医源性颅内动脉瘤患者的诊治经验。

Traumatic intracranial aneurysms don’t belong to the common complications of traumatic brain injury,but its mortality rate is extremely high,which acts as an important cause of delayed death.The highest risk of traumatic intracranial aneurysm rupture was happened at 2-3 weeks after injury,probably it’s presented as sudden intracranial hemorrhage,subarachnoid hemorrhage or epistaxis.Early intracranial angiography was needed among the brain trauma patients suspected with aneurysm.As traumatic intracranial aneurysms are mainly pseudoaneurysms,lacking the complete vascular wall and neck are lacked,and their clinical treatment is different from the spontaneous aneurysms.In addition to the craniotomy,simple coil embolization,stent assisted coil embolization,covered stent and low porosity flow guide device mean to have been applied in the treatment of traumatic intracranial aneurysms.The risk factors pathogenesis,classification and treatment methods of traumatic intracranial aneurysm were reviewed,and the experiences of two cases of traumatic and iatrogenic intracranial aneurysms were shared in this paper.