Zhang Danfeng, Chen Jigang, Han Kaiwei, Yu Mingkun, Hou Lijun
Department of Neurosurgery, Shanghai Institute of Neurosurgery, Shanghai Changzheng Hospital, 415 Fengyang Road, Shanghai 200003, China.
Biomed Res Int. 2017;2017:2838167. doi: 10.1155/2017/2838167. Epub 2017 Jul 30.
Penetrating skull base injury (PSBI) is uncommon among head injuries, presenting unique diagnostic and therapeutic challenges. Although many cases of PSBIs have been reported, comprehensive understanding of its initial diagnosis, management, and outcome is still unavailable.
A retrospective review was performed for patients treated in neurosurgical department of Changzheng Hospital for PSBIs. Presurgical three-dimensional (3D) Slicer-assisted reconstructions were conducted for each patient. Then we reviewed previous literature about all the published cases of PSBIs worldwide and discussed their common features.
A total of 5 patients suffering PSBIs were identified. Penetrating points as well as the surrounding neurovascular structures were clearly visualized, assisting in the presurgical planning of optimal surgical approach and avoiding unexpected vascular injury. Four patients underwent craniotomy with foreign bodies removed successfully and 1 patient received conservative treatment. All of them presented good outcomes after proper management.
Careful physical examination and radiological evaluation are essential before operation, and angiography is recommended for those with suspected vascular injuries. 3D modeling with 3D Slicer is practicable and reliable, facilitating the diagnosis and presurgical planning. Treatment decision should be made upon the comprehensive evaluation of patient's clinicoradiological features and characteristics of foreign bodies.
穿透性颅底损伤（PSBI）在颅脑损伤中并不常见，带来了独特的诊断和治疗挑战。尽管已有许多PSBI病例的报道，但对其初始诊断、治疗及预后仍缺乏全面认识。
对在长征医院神经外科接受治疗的PSBI患者进行回顾性研究。为每位患者进行术前三维（3D）Slicer辅助重建。然后我们回顾了全球所有已发表的PSBI病例的相关文献，并讨论了它们的共同特征。
共确定5例PSBI患者。穿透点及周围神经血管结构清晰可见，有助于术前规划最佳手术入路并避免意外血管损伤。4例患者接受开颅手术并成功取出异物，1例患者接受保守治疗。经过适当处理，所有患者预后良好。
术前仔细的体格检查和影像学评估至关重要，对于怀疑有血管损伤的患者建议进行血管造影。利用3D Slicer进行三维建模可行且可靠，有助于诊断和术前规划。应根据患者的临床影像学特征和异物特点综合评估后做出治疗决策。
