Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stems

Object. The authors describe their preliminary clinical experience with the use of endovascular stents in the treatment of traumatic vascular lesions of the skull base region. Because adequate distal exposure and direct surgi cal repair of these lesions are not often possible, conventional treatment has been deliberate arterial occlusion. The purpose of this report is to de monstrate the safety and efficacy as well as limitations of endovascular st ent placement in the management of craniocervical arterial injuries. Methods. Six patients with vascular injuries were treated using endovascula r stents. There were two arteriovenous fistulas and two pseudoaneurysms of the distal extracranial internal carotid or vertebral arteries resulting fr om penetrating trauma, and two petrous carotid pseudoaneurysms associated w ith basal skull fractures. In one patient a porous stent placement procedur e was undertaken as well as coil occlusion of an aneurysm, whereas in the r emaining five patients covered stent grafts were used as definitive treatme nt. There were no procedural complications. One patient in whom there was exten sive traumatic arterial dissection was found to have asymptomatic stent thr ombosis when angiography was repeated 1 week postoperatively. This was the only patient whose associated injuries precluded routine antithrombotic or antiplatelet therapy. Follow-up examinations in the remaining five patients included standard angiography (four patients) or computerized tomography a ngiography (one patient), which were performed 3 to 6 months postoperativel y, and clinical assessments ranging from 3 months to 1 year in duration (me an 9 months). In all five cases the vascular injury was successfully treate d and the parent artery remained widely patent. No patient experienced aneu rysm recurrence or hemorrhage, and there were no thromboembolic complicatio ns. Conclusions. The authors' experience demonstrates that endovascular treatme nt of traumatic vascular lesions of the skull base region is both feasible and safe. The advantages of minimally invasive stent placement and parent a rtery preservation make this procedure for repair of neurovascular injuries a potentially important addition to existing methods.