BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct ...BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.展开更多
The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of trauma...The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.展开更多
Purpose:Auditory nerve injury is one of the most common nerve injury complications of skull base fractures.However,there is currently a lack of auxiliary examination methods for its direct diagnosis.The purpose of thi...Purpose:Auditory nerve injury is one of the most common nerve injury complications of skull base fractures.However,there is currently a lack of auxiliary examination methods for its direct diagnosis.The purpose of this study was to find a more efficient and accurate means of diagnosis for auditory nerve injury.Methods:Through retrospectively analyzing the results of brainstem auditory evoked potential(BAEP)and high-resolution CT(HRCT)in 37 patients with hearing impairment following trauma from January 1,2018 to July 31,2020,the role of the two inspection methods in the diagnosis of auditory nerve injury was studied.Inclusion criteria were patient had a clear history of trauma and unilateral hearing impairment after trauma;while exclusion criteria were:(1)severe patient with a Glasgow coma scale score<5 because these patients were classified as severe head injury and admitted to the intensive care unit,(2)patient in the subacute stage admitted 72 h after trauma,and(3)patient with prior hearing impairment before trauma.According to Goodman's classification of hearing impairment,the patients were divided into low/medium/severe injury groups.In addition,patients were divided into HRCT-positive and negative groups for further investigation with their BAEP results.The positive rates of BEAP for each group were observed,and the results were analyzed by Chi-square test(p<0.05,regarded as statistical difference).Results:A total of 37 patients were included,including 21 males and 16 females.All of them were hospitalized patients with GCS score of 6-15 at the time of admission.The BAEP positive rate in the medium and severe injury group was 100%,which was significantly higher than that in the low injury group(27.27%)(p<0.01).The rate of BEAP positivity was significantly higher in the HRCT-positive group(20/30,66.7%)than in the HRCT-negative group(1/7,14.3%)(p<0.05).Twenty patients(54.05%)were both positive for BEAP and HRCT test,and considered to have auditory nerve damage.Six patients(16.22%)were both negative for BEAP and HRCT test,and 10 patients(27.03%)were BAEP-negative but HRCT-positive:all the 16 patients were considered as non-neurological injury.The rest 1 case(2.70%)was BAEP-positive but HRCT-negative,which we speculate may have auditory nerve concussion.Conclusion:By way of BAEP combining with skull base HRCT,we may improve the accuracy of the diagnosis of auditory nerve injury.Such a diagnostic strategy may be beneficial to guiding treatment plans and evaluating prognosis.展开更多
Penetrating head injury is rare,and thus management of such injuries is non-standard.Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma.How...Penetrating head injury is rare,and thus management of such injuries is non-standard.Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma.However,because of the lack of microsurgical techniques in local hospitals,the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid(CSF)leak usually require a rational design for a secondary operation to deal with.We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye.The chopsticks passed through the orbit roof and penetrated the skull base.In subsequent days,the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department.Computed tomography including plain scan,three dimension recon-struction and computed tomographic angiography are used to determine the course and extent of head injury.A frontal craniotomy was performed.Three pieces of stick were found residual and removed with the comminuted orbit bone fragments.A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect.Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation.CSF external drainage system continued for 12 days,and was removed 10 days after tem-perature returned to normal.The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully.We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome,especially in secondary operation.Good postoperative recovery depends on successfully management before and after operation for possible complications as well.展开更多
文摘BACKGROUND Traumatic internal carotid artery(ICA)occlusion is a rare complication of skull base fractures,characterized by high mortality and disability rates,and poor prognosis.Therefore,timely discovery and correct management are crucial for saving the lives of such patients and improving their prognosis.This article retrospectively analyzed the imaging and clinical data of three patients,to explore the imaging characteristics and treatment strategies for carotid artery occlusion,combined with severe skull base fractures.CASE SUMMARY This case included three patients,all male,aged 21,63,and 16 years.They underwent plain film skull computed tomography(CT)examination at the onset of their illnesses,which revealed fractures at the bases of their skulls.Ultimately,these cases were definitively diagnosed through CT angiography(CTA)examinations.The first patient did not receive surgical treatment,only anticoagulation therapy,and recovered smoothly with no residual limb dysfunction(Case 1).The other two patients both developed intracranial hypertension and underwent decompressive craniectomy.One of these patients had high intracranial pressure and significant brain swelling postoperatively,leading the family to choose to take him home(Case 2).The other patient also underwent decompressive craniectomy and recovered well postoperatively with only mild limb motor dysfunction(Case 3).We retrieved literature from PubMed on skull base fractures causing ICA occlusion to determine the imaging characteristics and treatment strategies for this type of disease.CONCLUSION For patients with cranial trauma combined with skull base fractures,it is essential to complete a CTA examination as soon as possible,to screen for blunt cerebrovascular injury.
基金Supported by the Science and Technology Program of Nantong Health Committee,No.MA2019003 and No.MA2021017Science and Technology Program of Nantong City,No.Key003 and No.JCZ2022040Kangda College of Nanjing Medical University,No.KD2021JYYJYB025,No.KD2022KYJJZD019,and No.KD2022KYJJZD022.
文摘The internal carotid artery occlusion caused by head and neck trauma,also known as traumatic intracranial artery occlusion,is relatively rare clinically.Traumatic skull base fracture is a common complication of traumatic brain injury.Traumatic skull base fracture is one of the causes of traumatic internal carotid artery occlusion.If not detected early and treated in time,the prognosis of patients is poor.This editorial makes a relevant analysis of this disease.
文摘Purpose:Auditory nerve injury is one of the most common nerve injury complications of skull base fractures.However,there is currently a lack of auxiliary examination methods for its direct diagnosis.The purpose of this study was to find a more efficient and accurate means of diagnosis for auditory nerve injury.Methods:Through retrospectively analyzing the results of brainstem auditory evoked potential(BAEP)and high-resolution CT(HRCT)in 37 patients with hearing impairment following trauma from January 1,2018 to July 31,2020,the role of the two inspection methods in the diagnosis of auditory nerve injury was studied.Inclusion criteria were patient had a clear history of trauma and unilateral hearing impairment after trauma;while exclusion criteria were:(1)severe patient with a Glasgow coma scale score<5 because these patients were classified as severe head injury and admitted to the intensive care unit,(2)patient in the subacute stage admitted 72 h after trauma,and(3)patient with prior hearing impairment before trauma.According to Goodman's classification of hearing impairment,the patients were divided into low/medium/severe injury groups.In addition,patients were divided into HRCT-positive and negative groups for further investigation with their BAEP results.The positive rates of BEAP for each group were observed,and the results were analyzed by Chi-square test(p<0.05,regarded as statistical difference).Results:A total of 37 patients were included,including 21 males and 16 females.All of them were hospitalized patients with GCS score of 6-15 at the time of admission.The BAEP positive rate in the medium and severe injury group was 100%,which was significantly higher than that in the low injury group(27.27%)(p<0.01).The rate of BEAP positivity was significantly higher in the HRCT-positive group(20/30,66.7%)than in the HRCT-negative group(1/7,14.3%)(p<0.05).Twenty patients(54.05%)were both positive for BEAP and HRCT test,and considered to have auditory nerve damage.Six patients(16.22%)were both negative for BEAP and HRCT test,and 10 patients(27.03%)were BAEP-negative but HRCT-positive:all the 16 patients were considered as non-neurological injury.The rest 1 case(2.70%)was BAEP-positive but HRCT-negative,which we speculate may have auditory nerve concussion.Conclusion:By way of BAEP combining with skull base HRCT,we may improve the accuracy of the diagnosis of auditory nerve injury.Such a diagnostic strategy may be beneficial to guiding treatment plans and evaluating prognosis.
文摘Penetrating head injury is rare,and thus management of such injuries is non-standard.Early diagnosis and intraoperative comprehensive exploration are necessary considering the complexity and severity of the trauma.However,because of the lack of microsurgical techniques in local hospitals,the possible retained foreign bodies and other postoperative complications such as cerebrospinal fluid(CSF)leak usually require a rational design for a secondary operation to deal with.We present a case of a 15-year-old boy who was stabbed with a bamboo stick in his left eye.The chopsticks passed through the orbit roof and penetrated the skull base.In subsequent days,the patient sustained CSF leak and intracranial infection after an unsatisfied primary treatment in the local hospital and had to request a secondary operation in our department.Computed tomography including plain scan,three dimension recon-struction and computed tomographic angiography are used to determine the course and extent of head injury.A frontal craniotomy was performed.Three pieces of stick were found residual and removed with the comminuted orbit bone fragments.A pedicled temporalis muscle fascia graft was applied to repair the frontier skull base and a free temporalis muscle flap to seal the frontal sinus defect.Aggressive broad-spectrum antibiotics of vancomycin and meropenem were administrated for persistent fever after operation.CSF external drainage system continued for 12 days,and was removed 10 days after tem-perature returned to normal.The Glasgow coma scale score was improved to 15 at postoperative day 7 and the patient was discharged at day 22 uneventfully.We believe that appropriate preoperative surgical plan and thorough surgical exploration by microsurgery is essential for attaining a favorable outcome,especially in secondary operation.Good postoperative recovery depends on successfully management before and after operation for possible complications as well.
