视神经损伤合并颈内动脉损伤的早期诊断  

Early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury

作　　者：李永[1] 张天明[1] 康军[1] 赵景武[1] 王卫[1] 宋维贤[2] 周军[2] 梁熙虹[3] 傅继弟[1] 

机构地区：[1]首都医科大学附属北京同仁医院神经外科,100730 [2]首都医科大学附属北京同仁医院眼科,100730 [3]首都医科大学附属北京同仁医院介入放射科,100730

出　　处：《中华神经外科杂志》2014年第11期1089-1092,共4页Chinese Journal of Neurosurgery

摘　　要：目的 探讨视神经损伤合并颈内动脉损伤的早期诊断方法.方法 回顾性分析1 081例视神经损伤病例,应用CTA和（或）MRA进行初步筛查,其中合并颈内动脉损伤26例,分析发生颈内动脉损伤的受伤机制、临床表现、CT特点,以及治疗方法和效果等.结果 1 081例视神经损伤患者中合并颈内动脉损伤26例（发生率2.4％）,其中创伤性假性动脉瘤12例,创伤性颈动脉海绵窦瘘9例,创伤性假性动脉瘤合并颈动脉海绵窦瘘4例,海绵窦部硬脑膜动静脉瘘1例.17例接受血管内介入治疗：9例行球囊栓塞,6例行微弹簧圈栓塞,1例行球囊＋微弹簧圈栓塞,1例行Onyx胶栓塞;7例闭塞颈内动脉.1例眶内创伤性动脉瘤接受颅眶入路手术治疗.8例未行介入治疗者中1例瘘口自行闭合,2例死亡.结论 视神经损伤患者伤后有鼻出血史、早期头颅CT显示蛛网膜下腔出血、鼻窦CT显示蝶窦外侧壁骨折者应考虑到颈内动脉损伤的可能,头颅CTA和（或）MRA可作为初步筛查方法.确诊后应及时进行血管内介入治疗.Objective To explore the methods of early diagnosis of traumatic optic neuropathies combined with internal carotid artery injury.Methods A retrospective study of 1 081 cases of traumatic optic neuropathy from Apr.2007 to Apr.2012 was performed.The CT angiography and/or magnetic resonance angiography were used as screening tools for the suspicious patients.The mechanisms of injury,clinical manifestations and neuroradiological features of internal carotid artery injury patients were discussed.Results In 1 081 cases of traumatic optic neuropathy,26 cases（2.4％）combined with internal carotid artery injury：12 cases were traumatic pseudoaneurysm,9 traumatic carotid cavernous fistula,4 traumatic pseudoaneurysm combined with carotid cavernous fistula,1 dural arteriovenous fistula.17 cases were treated by endovascular embolization,including detachable balloon technique in 10 cases,microcoils embolization in 7,and Onyx embolization in 1.The internal carotid artery was occluded in 7 cases.One intraorbital traumatic ophthalmic artery aneurysm was resected by cranio-orbital craniotomy.In the untreated team,2 cases died of hemorrhage.Conclusions For patients of traumatic optic neuropathies with unilateral blindness and posttraumatc epistaxis,if CT scan showed traumatic subarachnoid hemorrhage and fracture of the lateral wall of sphenoid sinus,CTA and/or MRA should be performed as the initial screening examination for internal carotid artery injury.As soon as a traumatic pseudoaneurysm was found,endovascular management should be initiated promptly.

关 键 词：创伤性视神经病变 创伤性蛛网膜下腔出血 颈内动脉 假性动脉瘤 

分 类 号：R651[医药卫生—外科学]