Traumatic aneurysms and arteriovenous fistulas of the extracranial vesselsin war injuries

BACKGROUND Extracranial vessel injuries are potentially devastating complications of p enetrating head and neck wounds associated with war conflicts. These vascul opathies may be occlusive or they may lead to formation of traumatic aneury sms (TA) and arteriovenous fistulae (AVF). Even though these penetrating in juries are usually clinically silent and often appear only as small superfi cial wounds, they may lead to catastrophic hemorrhage or vascular insult. I n this study, we attempted to elucidate signs, symptoms and circumstances p resent in these victims who are at risk of harboring an occult vasculopathy , excluding the occlusive ones and concentrating primarily on TAs and AVFs. MATERIALS AND METHODS In a prospective study conducted during 8 years of war between Iran and Ira q, we encountered 13 cases of traumatic vasculopathies of the extracranial carotid and vertebral arteries. The type and number of injuries were: carot id-jugular fistula (CJF) 3, carotid trunk or branch aneurysm (CA) 2, superf icial temporal artery aneurysm (STA) 3, vertebral artery aneurysm (VA) 2, v ertebral arteriovenous fistula (VAVF) 1, ophthalmic artery aneurysm (Oph. A n.) 1, and lingual artery aneurysm (Lin. An.) 1. Angiography was performed between the 5th and 30th day after the injury and surgical intervention was performed in all cases. RESULTS The Glasgow outcome scale (GOS) score was 13-15 in all victims at the time of discharge from the base hospital without any additional neurological def icit. The follow-up period varied from 5 to 8 years in all cases in whom no further morbidity or mortality occurred. Single photon emission computed t omography was the noninvasive tool used for measurement of cerebral blood f low in the cases in which a major vessel ligation was performed; no remarka ble change in cerebral blood flow was noted. CONCLUSION Early recognition of stigmas suggesting possible formation of extracranial traumatic vasculopathies such as TAs or AVFs in the difficult situation of war frontier hospitals should be highlighted for attending physicians or yo unger neurosurgeons. Performing angiography promptly in suspected cases can pick up such traumatic vascular lesions earlier. Using simpler surgical te chniques in situations in which more sophisticated endovascular equipment i s unavailable can be life-saving for these usually young victims. (C) 2000 by Elsevier Science Inc.