Clinical Analysis of Traumatic Cerebral Pseudoaneurysms

Abstract

ObjectiveTraumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes.MethodsThere were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis. The outcome was measured with modified Rankin Scale (mRS) score at 6 months after treatment.ResultsAll 8 patients were male and the mean age was 25 years old. Six of those were located at the cavernous segment of the internal carotid artery (ICA) and the other 2 was located at the M2 segment of middle cerebral artery. The causes of trauma were car accidents in 6, penetrating injury through the orbit in 1, and slip down injury in 1 patient. Massive epistaxis or hematemesis occurred in all patients with a pseudoaneurysm at the cavernous and ophthalmic segment of the ICA. All 6 patients of the cavernous and ophthalmic ICA group showed favorable outcome of mRS 0 to 1. The outcome of patients with middle cerebral artery pseudoaneurysm was mRS 2 to 3.ConclusionUpon prompt diagnosis and proper treatment planning, it is possible to achieve favorable outcome in these patients. Lesions located at the cavernous segment of the ICA favored endovascular treatment while those at the middle cerebral artery favored surgical treatment.

Intracranial Pseudoaneurysms: Evaluation and Management

“…Due to its proximity to other cavernous structures, including cranial nerves II, III, IV, V1, V2, and VI. Traumatic ICA pseudoaneurysms may present with cranial nerve deficits, unilateral blindness, or a carotid-cavernous fistula associated to skull base fractures (9,11,37,43). Other symptoms include headache, seizures, neck rigidity, decreased mental state, paralysis, or reduced level of consciousness.…”

Treatment of Intracranial Pseudoaneurysms With a Novel Covered Stent: A Series of 19 Patients With Midterm Follow-Up

“…Severe epistaxis, unilateral loss of vision, and cranial base fracture have been reported as the typical triad signs for traumatic pseudoaneurysms (7). Delayed and repeated epistaxis after head and facial trauma is the distinctive manifestation in most cases (6,8,20,22,27).…”

“…A triad of symptoms has been proposed as indications for intracranial traumatic pseudoaneurysms, which include massive epistaxis, unilateral blindness, and skull base fracture (7). Delayed repeated epistaxis after head and facial trauma is a distinctive manifestation of intracranial traumatic pseudoaneurysms (6).…”

<p>Traumatic Subarachnoid Hemorrhage Resulting from Posterior Communicating Artery Rupture</p>

“…Unlike an idiopathic aneurysm where a true aneurysm wall exists, a pseudoaneurysm does not have a true wall and cannot be packed with detachable coils. 17 Thus, the more applicable treatment option is total occlusion of the affective vessel. 17 In this case, we occluded the ruptured PCoA from the mid-to distal portion by an endovascular approach and checked the patency of collateral vessels.…”

“…17 Thus, the more applicable treatment option is total occlusion of the affective vessel. 17 In this case, we occluded the ruptured PCoA from the mid-to distal portion by an endovascular approach and checked the patency of collateral vessels. Because bleeding was ongoing during the DSA, we opted to perform immediate endovascular surgery rather than conventional open surgery.…”