Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base

Feiz-Erfan, Iman; Horn, Eric M.; Theodore, Nicholas; Zabramski, Joseph M.; Klopfenstein, Jeffrey D.; Leković, Gregory P.; Albuquerque, Felipe C.; Partovi, Shahram; Goslar, Pamela W.; Petersen, Scott R.

doi:10.3171/jns-07/08/0364

Cited by 38 publications

(57 citation statements)

References 35 publications

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“…In the first stage, imputation models were specified for predictors and for mortality at six months, considering other fullyobserved covariates (such as age and GCS score). In the second stage, for each of the previously imputed datasets, imputation models were specified for the Extended Glasgow Outcome Scale for those patients who were either known to be alive at six months or were predicted to be alive by the first stage imputation model, considering fully-observed covariates and intermediate endpoints [28,59] 30 [21,45] Male, n .8) 1116 (20.5) [2800]…”

Section: Handling Of Missing Datamentioning

confidence: 99%

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

Harrison

Griggs

Prabhu

et al. 2015

Journal of Neurotrauma

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This study validates risk prediction models for acute traumatic brain injury (TBI) in critical care units in the United Kingdom and recalibrates the models to this population. The Risk Adjustment In Neurocritical care (RAIN) Study was a prospective, observational cohort study in 67 adult critical care units. Adult patients admitted to critical care following acute TBI with a last pre-sedation Glasgow Coma Scale score of less than 15 were recruited. The primary outcomes were mortality and unfavorable outcome (death or severe disability, assessed using the Extended Glasgow Outcome Scale) at six months following TBI. Of 3626 critical care unit admissions, 2975 were analyzed. Following imputation of missing outcomes, mortality at six months was 25.7% and unfavorable outcome 57.4%. Ten risk prediction models were validated from Hukkelhoven and colleagues, the Medical Research Council (MRC) Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators, and the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) group. The model with the best discrimination was the IMPACT ''Lab'' model (C index, 0.779 for mortality and 0.713 for unfavorable outcome). This model was well calibrated for mortality at six months but substantially under-predicted the risk of unfavorable outcome. Recalibration of the models resulted in small improvements in discrimination and excellent calibration for all models. The risk prediction models demonstrated sufficient statistical performance to support their use in research and audit but fell below the level required to guide individual patient decision-making. The published models for unfavorable outcome at six months had poor calibration in the UK critical care setting and the models recalibrated to this setting should be used in future research.

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Section: Handling Of Missing Datamentioning

confidence: 99%

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

Harrison

Griggs

Prabhu

et al. 2015

Journal of Neurotrauma

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“…Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] .…”

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confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

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574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

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“…Angiography is a gold standard for traumatic aneurysm diagnosis. 7) In the present case, angiography also led to a diagnosis of a lesion of the external carotid artery system. Selective angiography through microcatheter insertion showed a pseudoaneurysm originating from the inferior orbital fissure-passing area of the infraorbital artery.…”

Section: Discussionmentioning

confidence: 89%

Traumatic Pseudoaneurysm in Maxillary Sinus Presenting Intractable Epistaxis: A Case Report of Transarterial Embolization

Hayashi

Matsuo

Hayashi

et al. 2017

JNET

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Objective: Craniofacial injury with fracture may lead to pseudoaneurysm formation in the external carotid artery system, causing massive epistaxis. In this study, we report a patient with intermittent epistaxis related to a traumatic aneurysm following right blow-out fracture, and review the literature with respect to the pathogenesis and treatment of traumatic aneurysms. Case Presentation:The patient is a 91-year-old male. He had undergone conservative treatment for right blow-out fracture because he fell down while walking. Subsequently, he had received medication with an iron preparation to control intermittent massive epistaxis. Six months after the head injury, he consulted the Department of Otorhinolaryngology with persistent epistaxis. In the right nasal cavity, a pulsatile mass was detected, suggesting a vascular lesion. He was referred to our department. Neurologically, there were no abnormalities, but marked anemia was noted, and blood transfusion was performed. Head CT revealed a mass occupying the right maxillary sinus. The mass was partially enhanced on contrast-enhanced CT. Angiography showed a pseudoaneurysm, measuring 8 × 10 × 15 mm, originating from a branch of the right internal maxillary artery. Subsequently, transarterial embolization was performed. A microcatheter was inserted to reach the aneurysm, and it was embolized using a liquid embolic material. After surgery, there was no epistaxis, and an improvement of anemia was achieved. Conclusion:In epistaxis patients with a history of craniofacial injury, it is necessary to differentiate traumatic aneurysms.Endovascular treatment is effective for traumatic aneurysms, and should be selected as a first-choice treatment.

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Incidence and pattern of direct blunt neurovascular injury associated with trauma to the skull base

Cited by 38 publications

References 35 publications

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

External Validation and Recalibration of Risk Prediction Models for Acute Traumatic Brain Injury among Critically Ill Adult Patients in the United Kingdom

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Traumatic Pseudoaneurysm in Maxillary Sinus Presenting Intractable Epistaxis: A Case Report of Transarterial Embolization

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