Surgical and Nonsurgical Treatment of Vascular Skull Base Trauma

Abstract

Vascular trauma is associated with blunt skull base fractures and penetrating injuries. We review the contemporary management of cranial vascular trauma, including blunt and penetrating cerebrovascular injury as well as refractory epistaxis from facial trauma.

Neuroendovascular Surgery Applications in Craniocervical Trauma

“…Carotid-cavernous fistula (CCF), a type of arteriovenous malformation, is typically associated with complex fractures of the skull base and can form as a result of cranial trauma ( Figure 3 ). Following injury, arterialization of the venous outflow from the cavernous sinus may result in the development of a myriad of symptoms, including visual deterioration, ophthalmoplegia, diplopia, headache, conjunctival chemosis, proptosis, pulsatile tinnitus, and ocular bruit [ 5 , 54 , 55 , 56 , 57 ]. These signs and symptoms may develop days to weeks following the initial traumatic event [ 5 ].…”

“…Indications for intervention include refractory elevation in intraocular pressure, severe diplopia, proptosis, optic neuropathy, retinal ischemia, severe ocular bruit, and cortical venous drainage. Cure rates approach 100% with endovascular techniques, with low rates of complications and mortality and the potential to restore oculomotor function and vision if early treatment is pursued [ 56 , 57 , 62 ]. Embolization may be achieved using detachable coils, balloons, liquid embolic agents, and/or flow-diverting stents, with the goal of therapy to occlude the fistulous point.…”

“…Embolization may be achieved using detachable coils, balloons, liquid embolic agents, and/or flow-diverting stents, with the goal of therapy to occlude the fistulous point. Transarterial embolization is the preferred approach; however, if the fistulous point cannot be accessed via arterial catheterization, a transvenous approach may be attempted by utilizing the inferior petrosal sinus or superior ophthalmic vein [ 57 ]. For cases with ICA dissections, flow-diverting stents serve as a potential adjuvant therapy to coil embolization by way of endoluminal reconstruction [ 56 , 63 , 64 ].…”

Neurointerventional management of cerebrovascular trauma

“…Своєчасна діагностика і лікування можуть запобіг-ти розвитку незворотних неврологічних ускладнень [5]. З удосконаленням техніки, досвіду та доказовості ендоваскулярних втручань нейрохірурги відіграють дедалі важливішу роль у лікуванні пацієнтів із травматичним цереброваскулярним ушкодженням [6][7][8][9]. У цій публікації наведено широкий огляд типових виявів, методів діагностики, відповідності скринінгу, класифікації ушкоджень та ведення пацієнтів із діагностованими або підозрю-…”

Neurointerventional management of cerebrovascular trauma

“…Timely diagnosis and management can prevent devastating neurological complications 5. With improvement in techniques, expertise, and evidence for endovascular interventions, neurointerventionalists play an increasingly important role in the treatment of patients with traumatic cerebrovascular injury 6–9. In this work, we provide a broad overview of the typical presentation, methods of diagnosis, appropriateness of screening, injury classification, and management of patients with known or suspected traumatic cerebrovascular injuries.…”