Levy M L, Rezai A, Masri L S, Litofsky S N, Giannotta S L, Apuzzo M L, Weiss M H
Department of Neurological Surgery, University of Southern California School of Medicine, Los Angeles.
Neurosurgery. 1993 Apr;32(4):532-40. doi: 10.1227/00006123-199304000-00007.
Certain clinical factors are considered to have an effect on patient outcome after penetrating missile injury. These include bilateral hemispheric injury, ventricular hemorrhage, intracerebral hemorrhage, mass effect, and missile or bony fragmentation. The relationship of subarachnoid hemorrhage (SAH) after penetrating craniocerebral injury and outcome is unknown. In addition, controversy exists regarding the role of angiography and the incidence of traumatic intracranial aneurysm in this population. Finally, can we assume that the incidence of traumatic intracranial aneurysm is equal in military and civilian populations, given the absence of penetrating shrapnel injury in civilian populations? Now that computed tomography has supplanted angiography as the primary diagnostic modality, increasing vigilance on the part of the physician and examination of angiography in high-risk patients should allow for enhanced outcome. We evaluated 100 patients with a diagnosis of cerebral gunshot wound over a 12-month period. All patients were evaluated neurologically at the time of admission and had imaging studies. Thirty-one patients with radiological evidence of SAH on computed tomography underwent angiography. Angiograms were limited to the side of the injury in patients with single-lobe or unilateral multilobe injuries and were bilateral in patients with bilateral hemispheric involvement. One intracranial aneurysm (3.2%) was documented and treated surgically. In those patients who died within 48 hours of admission, 68% had SAH as compared with only 17% of those surviving. Outcome was based upon neurological evaluation at the time of discharge and at the time of clinical follow-up at 3 and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
某些临床因素被认为会影响穿透性导弹伤后的患者预后。这些因素包括双侧半球损伤、脑室出血、脑内出血、占位效应以及导弹或骨碎片。穿透性颅脑损伤后蛛网膜下腔出血（SAH）与预后的关系尚不清楚。此外，关于血管造影的作用以及该人群中创伤性颅内动脉瘤的发生率存在争议。最后，鉴于 civilian populations 中不存在穿透性弹片伤，我们能否假设军事和 civilian populations 中创伤性颅内动脉瘤的发生率相等？既然计算机断层扫描已取代血管造影成为主要诊断方式，医生提高警惕并对高危患者进行血管造影检查应能改善预后。我们在12个月期间评估了100例诊断为脑枪伤的患者。所有患者入院时均进行了神经学评估并进行了影像学检查。31例计算机断层扫描有SAH放射学证据的患者接受了血管造影。对于单叶或单侧多叶损伤的患者，血管造影仅限于损伤侧，对于双侧半球受累的患者则为双侧。记录并手术治疗了1例颅内动脉瘤（3.2%）。在入院后48小时内死亡的患者中，68%有SAH，而存活患者中这一比例仅为17%。预后基于出院时以及3个月和6个月临床随访时的神经学评估。（摘要截断于250字） 注：原文中“civilian populations”未明确准确中文释义，这里保留英文。
