TRAUMATIC INTRACRANIAL CAROTID TREE ANEURYSMS

OBJECTIVE: This study was designed to elucidate the requirements for a ngiographic evaluation in blunt head injuries, the timing of angiograp hy, and the selection of appropriate therapeutic approaches. METHODS: Twelve cases of traumatic aneurysms (TAs) in the intracranial carotid tree were analyzed in this study. Neurological examination results, co mputed tomographic scans, pre- and postembolization cerebral angiogram s, and follow-up data were included. RESULTS: In 11 of 12 cases, TAs w ere of cranial base origin; in 1 case, the aneurysm was located in the distal anterior cerebral artery. In seven of the cases with cranial b ase lesions, aneurysms were located in the intracavernous segment of t he internal carotid artery; all of the computed tomographic scans for these cases demonstrated sphenoid sinus wall fractures and hematoma in the sphenoid sinus. In two cases, although the initial angiograms rev ealed no lesions, a second study performed 2 weeks later demonstrated the presence of aneurysms. Nine of the aneurysms were treated with end ovascular techniques, two were managed conservatively, and the remaini ng one patient died with massive epistaxis while awaiting surgical tre atment. No morbidity or additional permanent neurological deficits occ urred in the endovascularly treated patient group. CONCLUSION: Patient s with head trauma who present with sphenoid sinus fractures and massi ve epistaxis should be evaluated for the development of TAs as soon as possible. If the patients exhibit fractures without epistaxis, angiog raphy should be deferred for 2 to 3 weeks; if the first angiographic e valuation reveals normal findings, repeated epistaxis should prompt a second angiographic evaluation. Current treatment of TAs involves occl usion of the main artery through the use of endovascular techniques. C ases involving internal carotid artery TAs of cranial base origin and patients who do not tolerate test occlusion require extracranial-to-in tracranial bypass surgery.