颅脑外伤后假性动脉瘤致反复鼻出血的介入治疗

目的 总结颅脑外伤后反复鼻出血的介入治疗方法，探讨其疗效。方法 回顾性分析18例颅脑外伤后反复鼻出血患者的治疗方法。10例用可脱性球囊栓塞，7例用电解可脱弹簧圈（GDC）栓塞，1例因球囊反复栓塞时破裂，改行孤立术。结果 8例可脱性球囊一次栓塞成功，保留颈内动脉通畅。2例用2枚球囊连同颈内动脉一起闭塞。6例用GDC栓塞，保留颈内动脉通畅。1例上颌动脉假性动脉瘤用GDC 闭塞供血动脉。1例改行孤立术后拔除填塞纱条未再出血。17例介入治疗成功者即刻脑血管造影，均显示瘘口及假性动脉瘤消失。随诊1~5年均未再出现鼻出血。结论 介入性治疗颅脑外伤后反复鼻出血效果可靠，是目前首选的治疗方法。在无条件行介入治疗时，采用孤立手术仍不失为有效的治疗措施。

Interventional embolization treatment for intractable epistaxis due to pseudoaneurysm after craniocerebral trauma

Objective To summarize interventional embolization for intractable epistaxis after craniocerebral trauma, and evaluate its effectiveness. Methods Selection of interventional methods for 18 cases was retrospectively analyzed. 10 cases were treated with detachable balloon embolization, 7cases with Guglielmi detachable coil(GDC) embolization, and 1case with trapping because the balloon ruptured repeatedly. Results 8 embolizations were successfully performed with 1 balloon, and the patients′ internal carotid arteries were kept patency. 2 embolizations were performed with 2 balloons, with internal carotid arteries obliterated.6 embolizations were performed with GDC, but the patients′ arteries were kept patency. 1 case of maxillary artery pseudoaneurysm was embolized the artery with GDC. 1 case was treated with trapping of the fistula. After interventional treatment, Digital subtracted angiography (DSA) revealed complete obliteration of fistulas and pseudoaneurysms. In the follow-up of 1 to 5 years, no epistaxis was occurred. Conclusion Interventional embolization is the treatment of choice for traumatic intractable epistaxis. When interventional embolization is failed, trapping of the fistula is an effective therapy.