颅底骨折脑血管并发症

CLINICAL ANALYSIS OF CEREBRAL VESSEL INJURY INDUCED BY FRACTURE OF SKULL BASE

目的:探讨如何提高对颅底骨折脑血管并发症的认识和改善疗效。方法:统计并分析本院近3年来颅底骨折时脑血管并发症的种类、治疗方法及疗效。结果:1999.1-2002.1共收治因颅底骨折所致脑血管并发症15例,其中外伤性颈内动脉海绵窦瘘(TCCF)6例,颈内动脉假性动脉瘤(TPA)1例,颈内动脉闭塞2例,颈内动脉破裂致急性大出血2例,静脉窦破裂出血4例,其中TCCF和TPA均经血管内治疗的方法治愈,颈内动脉闭塞患者经内科保守治疗后遗留有一侧肢体的偏瘫,颈内动脉破裂大出血患者均死于出血性体克、窒息和/或脑疝,静脉窦破裂出血者采用开颅血肿清除、静脉窦修补和/或明胶海绵加EC胶压迫止血的方法进行治疗。其中1例因脑疝时间太长术后长期植物生存,其余则疗效良好。结论:颅底骨折时应注意有无脑血管并发症的存在,血管内治疗是TCCF和TPA的理想治疗方法。

Objective: To analyse how to improve the cognition of encephalon cerebral vessel injury induced by skull basal fracture and improve clinical curative effects. Methods:The kinds of blood vessel injury during skull basal fracture, therapy methods and curative effects of them were stated and analysed. Result: In the past 3 years, there were 15 cases of cerebral vessel inurry caused by skull basal fractre in ore hospital:6 cases of traumatic carotid caremous fistula(TCCF), 1 case of traumatic psedoaneurysm(TPA), 2 cases of carotid occlusion, 2 cases of corotid break and 4 cases of vein sinus break. The cases with TCCF and TPA were cured by the method of endovascular embolization. The cases of carotid occlusion induced the hemiplegia of one side of climbs through medical conservative therapy. The cases of corotid break died due to shock, asphyxy and encehalon hernia. The cases of vein sinus break were treated by purging hematoma, sinus mend, oppressive hemostasia with glutin sponge and EC pastern. One of them was severely disable and the others were complyetely recovered. Conclusion : Cerebral vessel complication of skull basal fracture should be noticed and treated in time. Embolization is the best way to treat TCCF and TPA.