State of the art: noninvasive imaging and management of neurovascular trauma

Abstract

Neurotrauma represents a significant public health problem, accounting for a significant proportion of the morbidity and mortality associated with all traumatic injuries. Both blunt and penetrating injuries to cervicocerebral vessels are significant and are likely more common than previously recognized. Imaging of such injuries is an important component in the evaluation of individuals presenting with such potential injuries, made all the more important since many of the vascular injuries are clinically silent. Management of injuries, particularly those caused by blunt trauma, is constantly evolving. This article addresses the current state of imaging and treatment of such injuries.

Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies

“…Other surgical risk assessment tools like the Charlson Comorbidity Index validated in over 5500 studies since 1987 for its ability to predict mortality based on co-morbidity [ 21 ], the Fitness Score [ 10 ] in major abdominal surgery (including emergency surgery) and Reiss Index [ 10 ] used specifically in laparotomies in elderly patients have all been used to assess the surgical risk. However, none of the scoring system has been specifically been assessed in patients undergoing emergency laparotomies across all age groups.…”

“…An ideal scoring system is desirable, so that an accurate prediction of outcome could then be made, allowing the treating team to present a more informed choice to the patient on whether surgery or supportive care is the optimal management [ 10 ]. It should also allow analysis for risk-adjusted comparison between surgeons, hospitals and across geographical distributions [ 11 ].…”

Vertebral Artery Injury with Coinciding Unstable Cervical Spine Trauma: Mechanisms, Evidence-based Management, and Treatment Options

“…The gold standard of diagnosis of VAI is digital subtraction angiography (DSA); however, computed tomography angiogram (CTA) has largely replaced DSA in most centers because of its time requirements and invasive nature [28,29]. Magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) is also a useful imaging tool, and may also be used to diagnose ligamentous injury and spinal cord damage concurrently [30,31]. Neither CTA nor MRI/MRA have the sensitivity or specificity of DSA in diagnosing VAI.…”

Endovascular Management of Neurovascular Arterial Injuries in the Face and Neck

“…These categories include: (1) intimal and/or medial damage with or without associated narrowing of the vessel lumen and/or dissection of the vessel, (2) aneurysm or pseudoaneurysm, (3) complete occlusion, (4) arteriovenous fistula, and (5) complete transection. 6 It is important to understand that vascular injuries are dynamic lesions that can combine several of the characteristics described above and, with time, evolve from one category to another. This potential for evolution emphasizes the need for careful follow-up imaging studies, as it will be shown below (see Fig.…”

“…These injuries can produce ischemia from vessel lumen narrowing or complete occlusion, or embolization of thrombus arising from pseudoaneurysms or dissection. 19 TREATMENT Treatment for neurovascular trauma includes conservative management as well as various surgical and endovascular options. If a patient is medically stable, angiography can be performed to both establish a firm diagnosis and proceed with endovascular treatment when indicated.…”