Results of Endovascular Treatment of Traumatic Intracranial Aneurysms

Abstract

Early angiographic diagnosis with immediate endovascular treatment provided an effective approach for TICA detection and management. Endovascular therapy is versatile and offers a valuable alternative to surgery, allowing early aneurysm exclusion with excellent results.

Cerebrovascular complications of transorbital penetrating intracranial injuries

“…This is contrary to the more commonly encountered "peripheral" location of vascular injury secondary to PHI in general. [19] In this series, all of the vascular injuries were central (internal carotid, anterior cerebral, proximal middle cerebral).…”

“…These authors state that the incidence among survivors ranges from 3 to 42%, and they emphasize that previous reports mainly focus on the aneurysms. Despite the contradicting epidemiologic and etiologic data about these aneurysms, [19] it is put forward that among all intracranial aneurysms, only 0.4 to 0.7 percent are traumatic and only one fifth of these traumatic aneurysms are secondary to penetration of the head. [18] The incidence of cavernous fistula secondary to penetrating head injury is even more obscure and appears to be even lower compared to aneurysms.…”

“…The occurrence of transorbital penetrating brain injury is, therefore, uncommon. [6] On the other hand, it is rare to encounter traumatic vascular injury after any kind of penetrating brain injury [19] so it is ostensible that TIPVI is very rare. As a matter of fact, in a series of 35 patients with penetrating orbitocranial gunshot injuries, no vascular injury has been noted.…”

“…We were able to identify only 15 documented cases during the last two centuries since the early 1800s. [10,17,19,[28][29][30] Interestingly, in four of these 14 cases, the anterior cerebral artery was involved, the internal carotid artery/anterior choroidal artery was involved in 4, we were not able to ascertain the exact location of the aneurysms in 7 cases from the data available. As for high velocity injury, we were able to identify only four cases of intracranial aneurysms/transections secondary to high velocity TIPI since 1999.…”

“…Since low-velocity objects can reach the cerebral vessels relatively easily through the orbit, a high index of suspicion is needed for detection of traumatic intracranial aneurysms due to low-velocity penetrating trauma. These lesions are insidious, [19] may result in the so called "talk and die" type of injury [22] or tend to rupture later in the subacute phase or even go into chronic phase undetected. Cases 2 and 5 are examples of enlarging/rupturing traumatic intracranial aneurysms, Case 1 is an example that was followed into the chronic phase.…”