Rostomily R C, Newell D W, Grady M S, Wallace S, Nicholls S, Winn H R
Department of Neurological Surgery, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104, USA.
J Trauma. 1997 Jan;42(1):123-32. doi: 10.1097/00005373-199701000-00023.
Penetrating trauma to the skull base and distal cervical internal carotid artery (ICA) can result in occlusion or pseudoaneurysm formation. The appropriate management strategy for these rare lesions is controversial and includes observation, anticoagulation, carotid ligation, balloon occlusion, or revascularization.
We present the management and outcomes of four consecutive patients, two with pseudoaneurysms and two with acute occlusions, after injury to the distal cervical/petrous ICA from gunshot wounds. Preoperative assessment determined intracranial collateral flow patterns and the patency of the distal portion of the petrous ICA.
Two patients underwent cervical-to-petrous ICA vein bypass grafts without neurologic complications. Both grafts remain patent without evidence of emboli at 2 years and 3 months, respectively. Both of the conservatively managed patients died, one from a massive cerebral infarction and the other from intracerebral hemorrhage.
These cases underscore the need for an aggressive approach to the assessment and management of patients with penetrating vascular skull-base injuries. Although the optimal treatment of remains controversial, when the goal is exclusion of the injured portion of the carotid artery and revascularization, the cervical to petrous ICA vein bypass graft is a valuable management option that can reduce the potential morbidity and mortality from acute ischemic or delayed embolic or hemorrhagic complications, provide immediate restoration of high flow, and allow good surgical access with minimal risk to intracranial structures.
颅底及颈段颈内动脉（ICA）远端穿透性创伤可导致血管闭塞或假性动脉瘤形成。对于这些罕见损伤的恰当处理策略存在争议，包括观察、抗凝、颈动脉结扎、球囊闭塞或血管重建。
我们介绍了4例因枪伤导致颈段/岩骨段ICA远端损伤患者的治疗情况及结果，其中2例为假性动脉瘤，2例为急性闭塞。术前评估确定了颅内侧支血流模式及岩骨段ICA远端的通畅情况。
2例患者接受了颈段至岩骨段ICA静脉搭桥手术，无神经并发症。2根移植血管分别在2年和3个月时保持通畅，无栓子迹象。2例保守治疗的患者均死亡，1例死于大面积脑梗死，另1例死于脑出血。
这些病例强调了对于穿透性颅底血管损伤患者需采取积极的评估和治疗方法。尽管最佳治疗方案仍存在争议，但当目标是排除颈动脉损伤段并进行血管重建时，颈段至岩骨段ICA静脉搭桥手术是一种有价值的治疗选择，可降低急性缺血或延迟性栓塞或出血并发症导致的潜在发病率和死亡率，立即恢复高流量，并以对颅内结构最小的风险实现良好的手术入路。
