Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Neurosurgery. 2011 Jun;68(6):E1750-4; discussion E1754-5. doi: 10.1227/NEU.0b013e31821713fb.
To present a case of traumatic cortical and dural arteriovenous fistula (AVF) after a BB gun accident.
The patient presented with a small left frontal subdural hematoma and small contusions in the left frontal lobe after he was shot with a BB. He had no skull fractures or significant midline shift. The patient, who was neurologically intact, was discharged after 3 days of observation and having undergone serial computed tomography imaging. Five days later, the patient developed lethargy and emesis. Computed tomography showed a 5 × 3 × 5 cm intraparenchymal hematoma in the left frontal lobe. Emergency evacuation of the hematoma revealed a cortical AVF, which was resected. Postoperative angiography showed a dural AVF of the left middle meningeal artery, draining into the superior ophthalmic vein and a dural vein. The dural AVF was embolized with n-butyl cyanoacrylate. The patient was discharged after 3 days with no deficits.
The subdural hematoma and contusions were caused by a BB, which often are used in low-velocity and small caliber weapons. Not all BB guns are low velocity, and the consequences can be dramatic. The BB gun used here was pneumatic. The patient had no skull fractures. Several days of stable imaging and normal examinations suggested nothing sinister. His initial bleeds appeared disproportionate to the mechanism. The delayed presentation of the debilitating hematoma in this case stresses the need for vigilance on the part of practitioners and families when patients have a suspicious bleed.
介绍一例因气枪意外导致的创伤性皮质和硬脑膜动静脉瘘（AVF）。
患者被气枪击中后，出现左额部小的硬脑膜下血肿和左额叶小挫裂伤，无颅骨骨折或明显中线移位。患者神经功能完整，观察 3 天后，连续行 CT 检查，病情稳定后出院。5 天后，患者出现嗜睡和呕吐。CT 显示左额叶内有一个 5×3×5cm 的脑内血肿。紧急血肿清除后发现皮质 AVF，予以切除。术后血管造影显示左脑膜中动脉硬脑膜 AVF，引流至上眼静脉和硬脑膜静脉。用正丁基氰基丙烯酸酯栓塞硬脑膜 AVF。患者术后 3 天无神经功能缺损出院。
硬脑膜下血肿和挫裂伤是由气枪引起的，气枪通常用于低速度和小口径武器。并非所有气枪都是低速度的，其后果可能是严重的。此处使用的气枪是气动的。患者无颅骨骨折。数天稳定的影像学和正常的检查提示没有恶性病变。他最初的出血似乎与机制不成比例。在这种情况下，迟发性严重血肿的表现强调了在患者出现可疑出血时，医生和家属需要保持警惕。
