Management of the Extracranial and Intracranial Traumatic Arterial Lesions.

Pi, Young Hoon; Rha, Hyoung Kyun; Lee, Kyung Jin; Park, Hea Kwan; Cho, Jeong Gi; Baek, Min Woo; Kim, Dal Soo; Kim, Mun Chan; Choi, Chang Rak

Original Article

Journal of Korean Neurosurgical Society 2002;32(3): 211-216.

Young Hoon Pi, Hyoung Kyun Rha, Kyung Jin Lee, Hea Kwan Park, Jeong Gi Cho, Min Woo Baek, Dal Soo Kim, Mun Chan Kim, Chang Rak Choi

Department of Neurosurgery, Catholic Neuroscience Center, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

OBJECTIVE
This study is designed to elucidate the requirements for angiographic evaluation and the selection of appropriate therapeutic approaches in patients who had strongly suggestive traumatic carotid arterial lesions.
METHODS
Ten cases of traumatic internal carotid arterial lesions were analysed in this study. Injury mechanisms, neurological status, computed tomography scans, pre-and postoperative angiograms, and methods and results of the treatment were included.
RESULTS
Of 10 cases, carotid-cavernous fistula(CCF) alone in three, CCF with intracranial pseudoaneurysms in three, pseudoaneurysm with dissection in one, extracranial internal carotid artery thrombosis in one, extracranial pseudoaneurysm in one, and the remaining one had all of the CCF, intracranial pseudoaneurysm and dissection. Seven of these 10 cases had sphenoid sinus wall fractures and six had subarachnoid hemorrhage. Six cases were treated with endovascular techniques, and four with direct parent artery occlusion and bypass surgery. No postoperative morbidity or additional permanent neurological deficits occurred except one patient who suffered from reperfusion hemorrhage after bypass surgery.
CONCLUSION
Head trauma patients with facial bone fractures and thick subarachnoid hemorrhage should be evaluated for the development of traumatic injuries to the carotid artery as soon as possible. Endovascular treatment to these lesions have come to play an increasing role. Patients with traumatic internal carotid artery lesions who do not tolerate test occlusion require extracranial to intracranial bypass surgery before occlusion.

Key Words: Head trauma; Traumatic carotid arterial lesions; Endovascular technique; Revascularization