Chen D, Concus A P, Halbach V V, Cheung S W
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA.
Laryngoscope. 1998 Mar;108(3):326-31. doi: 10.1097/00005537-199803000-00004.
Posttraumatic pseudoaneurysm of the internal carotid artery (ICA) is an uncommon but potentially fatal cause of epistaxis. Because the onset of delayed bleeding from the time of injury is variable, prompt diagnosis of cavernous ICA pseudoaneurysm is often a clinical challenge. The relative urgency to evaluate for this disease is highlighted by the morbid nature of this entity. Optimal management demands rapid recognition and treatment to give the best functional outcome. The authors present a case series of six patients with skull base ICA pseudoaneurysm. A unifying feature in the majority of patients is the development of delayed, massive epistaxis. The time course for presentation of delayed life-threatening epistaxis ranged from 5 days to 9 weeks. Two patients exhibited the classic triad of unilateral blindness, orbital fractures, and massive epistaxis. All patients requiring intervention were successfully treated with endovascular embolization techniques that included detachable balloons and coils. The clinical and radiologic findings in this case series are presented. The relevant anatomy, diagnosis, and treatment of traumatic ICA pseudoaneurysm are reviewed. A contemporary treatment strategy is proposed.
创伤性颈内动脉（ICA）假性动脉瘤是鼻出血的一种罕见但可能致命的原因。由于受伤后延迟出血的发作时间不一，海绵窦ICA假性动脉瘤的及时诊断常常是一项临床挑战。该疾病的严重性凸显了对其进行评估的相对紧迫性。最佳治疗需要快速识别和治疗，以获得最佳功能结果。作者报告了一组6例颅底ICA假性动脉瘤患者的病例系列。大多数患者的一个共同特征是出现延迟性大量鼻出血。延迟出现危及生命的鼻出血的时间范围为5天至9周。两名患者表现出单侧失明、眼眶骨折和大量鼻出血的典型三联征。所有需要干预的患者均通过包括可脱性球囊和弹簧圈在内的血管内栓塞技术成功治疗。本文介绍了该病例系列的临床和影像学表现。回顾了创伤性ICA假性动脉瘤的相关解剖、诊断和治疗。提出了一种当代治疗策略。
