Gu H B, Li B, Zhang E P, Shi L, He M Q, Shi G G
Department of Otorhinolaryngology Head and Neck Surgery, Shandong Provincial Hospital, Affiliated to Shandong First Medical University, Jinan 250021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jan 7;56(1):18-25. doi: 10.3760/cma.j.cn115330-20201119-00879.
To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.
探讨颅底颈内动脉瘤的诊断及临床特点。收集并分析了1995年至2017年在山东第一医科大学附属省立医院经数字减影血管造影（DSA）或CT血管造影（CTA）诊断并治疗的15例颅底颈内动脉瘤患者的数据。15例患者中，男性12例，女性3例，年龄17至67岁，中位年龄44岁。13例患者经DSA诊断；另外2例经CTA诊断。13例诊断为假性动脉瘤，首发症状为鼻出血，其中8例有头部外伤史，5例曾接受颅底肿瘤放疗。另外2例诊断为真性动脉瘤，表现为头痛和脑神经障碍。所有患者治疗后随访2至12年，观察是否治愈及存活情况。有外伤史的8例患者中，5例经栓塞治愈，2例未行栓塞治疗因大量鼻出血死亡，1例栓塞后死于进行性脑梗死。有颅底肿瘤放疗史的5例患者中，1例栓塞后死于脑梗死，2例因原发肿瘤复发及颅内侵犯出院死亡，1例栓塞及手术后恢复良好，1例放弃治疗死于院外大出血。另外2例有头痛症状的患者中，1例误手术后在院外接受栓塞治疗，另1例放弃治疗因个人原因死亡。总计4例住院死亡，4例院外死亡，7例存活。颅底颈内动脉瘤是前、中颅底的高危疾病。对于有外伤和放疗史且出现鼻出血的患者或有头痛及脑神经障碍的患者，应考虑颈内动脉瘤的可能性，其中DSA或CTA检查是确保诊断和病情评估的基本要求。耳鼻喉科医生的正确诊断和治疗对患者的预后至关重要。
