Kobata Hitoshi
Department of Neurosurgery, Osaka Mishima Emergency Critical Care Center.
Neurol Med Chir (Tokyo). 2017 Aug 15;57(8):410-417. doi: 10.2176/nmc.oa.2017-0056. Epub 2017 Jun 30.
Traumatic cerebrovascular injury (TCVI) is an uncommon clinical entity in traumatic brain injury (TBI), yet it may cause devastating brain injury with high morbidity and mortality. Early recognition and prioritized strategic treatment are of paramount importance. A total of 1966 TBI patients admitted between 1999 and 2015 in our tertiary critical care center were reviewed. Screening of TCVI was based on the Guidelines for the Management of Severe Head Injury in Japan. TCVI was confirmed in 33 (1.7%) patients; 29 blunt and 4 penetrating injuries. The primary location of the injury included 16 cervical, 6 craniofacial, and 11 intracranial lesions. On arrival, 15 patients presented with hemorrhage, 5 of these arrived in shock status with massive hemorrhage. Ten presented with ischemic symptoms. Sixteen patients underwent surgical or endovascular intervention, 13 of whom required immediate treatment upon arrival. Surgical procedures included clipping or trapping for traumatic aneurysms, superficial temporal artery - middle cerebral artery bypass, carotid endarterectomy, and direct suture of the injured vessels. Endovascular intervention was undertaken in 7 patients; embolization with Gelfoam (Pharmacia and Upjohn Company, Kalamazoo, MI, USA) or coil for 6 hemorrhagic lesions and stent placement for 1 lesion causing ischemia. Patients' outcome assessed by the Glasgow Outcome Scale at 3 months were good recovery in 8, moderate disability in 3, severe disability in 9, persistent vegetative state in 1, and death in 12, respectively. In order to rescue potentially salvageable TCVI patients, neurosurgeons in charge should be aware of TCVI and master basic skills of cerebrovascular surgical and endovascular procedures to utilize in an emergency setting.
创伤性脑血管损伤（TCVI）在创伤性脑损伤（TBI）中是一种不常见的临床病症，但它可能导致具有高发病率和死亡率的毁灭性脑损伤。早期识别和优先进行的策略性治疗至关重要。对1999年至2015年期间在我们三级重症监护中心收治的1966例TBI患者进行了回顾。TCVI的筛查基于日本《重型颅脑损伤管理指南》。在33例（1.7%）患者中确诊为TCVI；29例为钝器伤，4例为穿透伤。损伤的主要部位包括16例颈部、6例颅面部和11例颅内病变。入院时，15例患者出现出血，其中5例因大量出血处于休克状态。10例出现缺血症状。16例患者接受了手术或血管内介入治疗，其中13例在入院后需要立即治疗。手术操作包括对创伤性动脉瘤进行夹闭或包裹、颞浅动脉-大脑中动脉搭桥、颈动脉内膜切除术以及对受损血管进行直接缝合。7例患者接受了血管内介入治疗；6例出血性病变采用明胶海绵（美国密歇根州卡拉马祖市法玛西亚和厄普约翰公司）或弹簧圈栓塞，1例导致缺血的病变进行了支架置入。3个月时根据格拉斯哥预后量表评估患者的预后，分别为8例恢复良好、3例中度残疾、9例重度残疾、1例持续植物状态和12例死亡。为了挽救可能可救治的TCVI患者，负责的神经外科医生应了解TCVI并掌握脑血管外科手术和血管内操作的基本技能，以便在紧急情况下应用。
