Chun Hyoung-Joon, Yi Hyeong-Joong
Department of Neurosurgery, Hanyang University Medical Center, Seoul 133-792, South Korea.
Surg Neurol. 2009 Jun;71(6):701-4. doi: 10.1016/j.surneu.2007.11.018. Epub 2008 Mar 3.
Extracranial pseudoaneurysm is barely noticed after head injury, and therefore, recognizing such sequels is amenable when there is severe initial injury, unexplained intracranial bleeding, or neurologic sequelae. We report such an unexpected case of intraorbital pseudoaneurysm presenting as delayed intraparenchymal hemorrhage.
A 71-year-old man with traumatic brain injury sustained delayed intraparenchymal hemorrhage after unremarkable surgical evacuation. Suspicious intraorbital mass was shown adjacent to the fracture line of medial orbital wall. Catheter angiogram revealed peripheral, extracranial ophthalmic artery pseudoaneurysm, and endovascular occlusion was attempted. The patient made gradual recovery with radiographic evidence of disappeared pseudosac and resolved intracranial hematoma.
Traumatic aneurysm of peripheral ophthalmic artery should be strongly suspected when there is skull fracture at the orbital wall or persistent or delayed intraparenchymal hemorrhage despite proper surgical hematoma evacuation, and in such case, swift endovascular occlusion can be done safely.
头部受伤后颅外假性动脉瘤很少被注意到，因此，当存在严重的初始损伤、不明原因的颅内出血或神经后遗症时，识别此类后遗症是可行的。我们报告了这样一例意外的眶内假性动脉瘤病例，表现为延迟性脑实质内出血。
一名71岁的男性脑外伤患者在手术清除血肿后情况平稳，但出现了延迟性脑实质内出血。在眼眶内侧壁骨折线附近发现了可疑的眶内肿块。导管血管造影显示外周颅外眼动脉假性动脉瘤，并尝试进行血管内闭塞治疗。患者逐渐康复，影像学证据显示假性囊消失，颅内血肿消退。
当眼眶壁发生颅骨骨折，或尽管进行了适当的手术清除血肿，但仍存在持续性或延迟性脑实质内出血时，应高度怀疑外周眼动脉创伤性动脉瘤，在这种情况下，可以安全地迅速进行血管内闭塞治疗。
