Liang Wen, Xiaofeng Yang, Weiguo Liu, Wusi Qiu, Gang Shen, Xuesheng Zheng
Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, 31003, PR China.
J Trauma. 2007 Nov;63(5):1014-20; discussion 1020. doi: 10.1097/TA.0b013e318154c9fb.
Traumatic carotid cavernous fistula (TCCF) is a rare vascular complication of traumatic brain and facial injury. The purpose of this study was to analyze the incidence of this disorder in different types of basilar skull fracture, determine whether particular clinical factors impacted outcomes, and discuss ways of improving prognosis.
We performed a retrospective analysis of cases with basilar skull fracture or angiography-confirmed TCCF in inpatients between 1999 and 2005, as well as an analysis of the incidence rate of TCCF in each type of basilar skull fracture. For patients diagnosed with TCCF, cases were divided into "disability" and "no disability" groups, and related clinical factors with potential impact on prognosis were analyzed.
In 312 inpatients with basilar skull fractures, an overall incidence of 3.8% for TCCF was observed, and the incidence of this disorder with anterior fossa fracture, middle fossa fracture, and posterior fossa fracture was 2.4%, 8.3%, and 1.7%, respectively. In this retrospective analysis, factors such as patients' age, gender, number of embolization procedures performed, and time from injury to first symptom onset did not significantly affect outcome (p > 0.05). However, the time from first symptom onset to endovascular embolization differed significantly between the disability and no disability groups (p < 0.05).
A relatively high incidence of TCCF occurred in patients with middle fossa fractures, especially those with transverse or oblique fractures. Prompt diagnosis and intervention should be emphasized in the management of patients with TCCF, and noninvasive techniques for early detection of TCCF should be considered in cases of middle fossa fractures under certain conditions after brain or facial trauma to ensure positive outcomes.
创伤性颈内动脉海绵窦瘘（TCCF）是颅脑和颜面部损伤罕见的血管并发症。本研究旨在分析不同类型颅底骨折中该疾病的发生率，确定特定临床因素是否影响预后，并探讨改善预后的方法。
我们对1999年至2005年住院的颅底骨折或血管造影确诊为TCCF的病例进行回顾性分析，并分析每种类型颅底骨折中TCCF的发生率。对于诊断为TCCF的患者，将病例分为“致残”和“非致残”组，并分析对预后有潜在影响的相关临床因素。
在312例颅底骨折住院患者中，TCCF的总发生率为3.8%，前颅窝骨折、中颅窝骨折和后颅窝骨折患者中该疾病的发生率分别为2.4%、8.3%和1.7%。在这项回顾性分析中，患者的年龄、性别、栓塞治疗次数以及受伤至首次症状出现的时间等因素对预后无显著影响（p>0.05）。然而，致残组和非致残组从首次症状出现到血管内栓塞的时间差异有统计学意义（p<0.05）。
中颅窝骨折患者TCCF发生率相对较高，尤其是横形或斜形骨折患者。TCCF患者的治疗应强调早期诊断和干预，对于脑或颜面部创伤后特定情况下的中颅窝骨折患者，应考虑采用非侵入性技术早期检测TCCF，以确保良好预后。
