Steigerwald C, Draf W, Hofmann E, Minovi A, Behr R, Bockmühl U
Universitätsklinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Albert-Ludwigs-Universität Freiburg.
Laryngorhinootologie. 2005 Dec;84(12):910-4. doi: 10.1055/s-2005-870566.
In latero-basal, central or spheno-fronto-orbital skull base fractures the internal carotid artery is more frequently involved in severe lesions than expected.
Between 1996 and 2003 we examined 684 patients with Glasgow Coma Scales (GCS) between 2 and 15, median 7.2, using computed tomography (CT). In suspicion of a latero-basal, central or spheno-fronto-orbital fractur they got an additional high resolution skull base CT. If the bony canal of the internal carotid artery (ICA) was involved the patient underwent digital subtraction angiography (DSA). The ICA lesion was treated either interventional neuroradiologically, by surgery or only conservatively.
Of the 684 patients 33 (4.8 %) had fractures of the ICA bony canal and therefore underwent DSA. Among them were 25 men and 8 women (mean age 35.3 years). Lesions of the ICA were seen in 1.9 % of the patients. A traumatic cavernous-carotid fistula was found in 7 patients (1 %) and in 6 patients (0.9 %) a dissection and/or an aneurysm of the ICA was diagnosed. Six of the patients had clinical symptoms. The lesions were treated primarily interventional neuroradiologically (n = 5) as well as surgically in two cases by clipping the aneurysm and closing the sphenoid sinus, respectively.
Vessel lesions of the ICA in skull base fractures and involvement of the bony carotid canal are more frequent than mentioned in current literature. A solid diagnosis can only be achieved by DSA. Early diagnosis and treatment is important for improving the prognosis of these often multiply injured patients.
在颅底外侧 - 基底、中央或蝶 - 额 - 眶部骨折中，颈内动脉比预期更常出现严重损伤。
1996年至2003年间，我们对684例格拉斯哥昏迷量表（GCS）评分在2至15分（中位数7.2分）的患者进行了计算机断层扫描（CT）检查。怀疑存在颅底外侧 - 基底、中央或蝶 - 额 - 眶部骨折的患者，还接受了高分辨率颅底CT检查。如果颈内动脉（ICA）的骨性管道受累，患者则接受数字减影血管造影（DSA）检查。ICA损伤的治疗方法包括介入神经放射治疗、手术治疗或仅采取保守治疗。
684例患者中，33例（4.8%）存在ICA骨性管道骨折，因此接受了DSA检查。其中男性25例，女性8例（平均年龄35.3岁）。1.9%的患者发现了ICA损伤。7例患者（1%）发现了外伤性海绵窦 - 颈动脉瘘，6例患者（0.9%）诊断为ICA夹层和/或动脉瘤。6例患者有临床症状。这些损伤主要采用介入神经放射治疗（n = 5），2例患者分别通过夹闭动脉瘤和封闭蝶窦进行了手术治疗。
颅底骨折中ICA血管损伤及颈动脉骨性管道受累的情况比现有文献报道的更为常见。只有通过DSA才能做出确切诊断。早期诊断和治疗对于改善这些常合并多处损伤患者的预后非常重要。
