CAJ | 학술논문

目的探讨视神经损伤合并颈内动脉损伤的早期诊断方法.方法回顾性分析1 081例视神经损伤病例,应用CTA和(或)MRA进行初步筛查,其中合并颈内动脉损伤26例,分析发生颈内动脉损伤的受伤机制、临床表现、CT特点,以及治疗方法和效果等.结果 1 081例视神经损伤患者中合并颈内动脉损伤26例(发生率2.4％),其中创伤性假性动脉瘤12例,创伤性颈动脉海绵窦瘘9例,创伤性假性动脉瘤合并颈动脉海绵窦瘘4例,海绵窦部硬脑膜动静脉瘘1例.17例接受血管内介入治疗:9例行球囊栓塞,6例行微弹簧圈栓塞,1例行球囊+微弹簧圈栓塞,1例行Onyx胶栓塞;7例闭塞颈内动脉.1例眶内创伤性动脉瘤接受颅眶入路手术治疗.8例未行介入治疗者中1例瘘口自行闭合,2例死亡.结论视神经损伤患者伤后有鼻出血史、早期头颅CT显示蛛网膜下腔出血、鼻窦CT显示蝶窦外侧壁骨折者应考虑到颈内动脉损伤的可能,头颅CTA和(或)MRA可作为初步筛查方法.确诊后应及时进行血管内介入治疗.
목적 탐토시신경손상합병경내동맥손상적조기진단방법.방법 회고성분석1 081례시신경손상병례,응용CTA화(혹)MRA진행초보사사,기중합병경내동맥손상26례,분석발생경내동맥손상적수상궤제、림상표현、CT특점,이급치료방법화효과등.결과 1 081례시신경손상환자중합병경내동맥손상26례(발생솔2.4％),기중창상성가성동맥류12례,창상성경동맥해면두루9례,창상성가성동맥류합병경동맥해면두루4례,해면두부경뇌막동정맥루1례.17례접수혈관내개입치료:9례행구낭전새,6례행미탄황권전새,1례행구낭+미탄황권전새,1례행Onyx효전새;7례폐새경내동맥.1례광내창상성동맥류접수로광입로수술치료.8례미행개입치료자중1례루구자행폐합,2례사망.결론 시신경손상환자상후유비출혈사、조기두로CT현시주망막하강출혈、비두CT현시접두외측벽골절자응고필도경내동맥손상적가능,두로CTA화(혹)MRA가작위초보사사방법.학진후응급시진행혈관내개입치료.
Objective To explore the methods of early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury.Methods A retrospective study of 1 081 cases of traumatic optic neuropathy from Apr.2007 to Apr.2012 was performed.The CT angiography and/or magnetic resonance angiography were used as screening tools for the suspicious patients.The mechanisms of injury,clinical manifestations and neuroradiological features of internal carotid artery injury patients were discussed.Results In 1 081 cases of traumatic optic neuropathy,26 cases(2.4％)combined with internal carotid artery injury:12 cases were traumatic pseudoaneurysm,9 traumatic carotid cavernous fistula,4 traumatic pseudoaneurysm combined with carotid cavernous fistula,1 dural arteriovenous fistula.17 cases were treated by endovascular embolization,including detachable balloon technique in 10 cases,microcoils embolization in 7,and Onyx embolization in 1.The internal carotid artery was occluded in 7 cases.One intraorbital traumatic ophthalmic artery aneurysm was resected by cranio-orbital craniotomy.In the untreated team,2 cases died of hemorrhage.Conclusions For patients of traumatic optic neuropathies with unilateral blindness and posttraumatc epistaxis,if CT scan showed traumatic subarachnoid hemorrhage and fracture of the lateral wall of sphenoid sinus,CTA and/or MRA should be performed as the initial screening examination for internal carotid artery injury.As soon as a traumatic pseudoaneurysm was found,endovascular management should be initiated promptly.