Kobata Hitoshi
Osaka Mishima Emergency Critical Care Center.
No Shinkei Geka. 2021 Sep;49(5):1041-1055. doi: 10.11477/mf.1436204488.
Traumatic cerebrovascular injury(TCVI)is an infrequent clinical entity caused by trauma to the head and neck. However, it may lead to devastating brain injury with high morbidity and mortality. Therefore, early diagnosis and prioritized strategic treatment are essential to rescue affected patients. Three-dimensional CT angiography is the preferred method for screening of TCVI. Digital subtraction angiography can produce high-resolution images of injury and is used as the gold standard imaging method. It also allows undertaking endovascular treatment when necessary. TCVI can be classified by a combination of(1)pathogenesis: perforating or non-penetrating(blunt); (2)anatomical location: neck, craniofacial, or intracranial; and(3)pathogenesis: ischemic, hemorrhagic, or others(e.g., arteriovenous fistula). Treatment varies according to the pathology and severity of TCVI. Ten cases of various TCVI have been presented and discussed to outline the primary diagnostic and therapeutic essence. To provide prompt and accurate treatment for patients with TCVI, neurosurgeons in charge should be aware of TCVI and master fundamental skills of cerebrovascular surgical and endovascular procedures to apply in an emergency setting.
创伤性脑血管损伤(TCVI)是一种由头颈部创伤引起的少见临床病症。然而,它可能导致毁灭性的脑损伤,具有高发病率和死亡率。因此,早期诊断和优先的策略性治疗对于救治受影响的患者至关重要。三维CT血管造影是筛查TCVI的首选方法。数字减影血管造影可以生成损伤的高分辨率图像,被用作金标准成像方法。它还允许在必要时进行血管内治疗。TCVI可根据以下因素进行分类:(1)发病机制:穿通性或非穿透性(钝性);(2)解剖位置:颈部、颅面部或颅内;以及(3)发病机制:缺血性、出血性或其他(如动静脉瘘)。治疗根据TCVI的病理和严重程度而异。本文介绍并讨论了10例不同类型的TCVI,以概述主要的诊断和治疗要点。为了为TCVI患者提供及时准确的治疗,负责的神经外科医生应了解TCVI,并掌握脑血管外科和血管内手术的基本技能,以便在紧急情况下应用。