颅内段颈内动脉创伤的诊断及血管内治疗

目的 探讨颅内段颈内动脉创伤的诊断和血管内治疗的临床价值.方法 11例颅内段颈内动脉病变的患者应用选择性全脑造影进行诊断,10例行颈内动脉栓塞治疗.所有资料采用回顾性分析.结果 3例颈内动脉假性动脉瘤,4例颈内动脉-海绵窦瘘,1例颈内动脉假性动脉瘤伴颈内动脉-海绵窦瘘及1例巨大蛇形动脉行球囊颈内动脉完全性栓塞,1例颈内动脉-海绵窦瘘行电解可脱式弹簧圈保留颈内动脉栓塞,1例放弃治疗.随访4个月～7年,1 0例颈内动脉病变的患者痊愈.结论 选择性全脑造影是外伤性颈内动脉损伤首选诊断方法,血管内治疗安全有效.     

海绵窦颈内动脉损伤所致严重鼻出血的血管内栓塞治疗(附2例报告)

报告海绵窦颈内动脉损伤引起严重鼻出血２例，其中１例为突入蝶窦的巨大假性动脉瘤，１例为已进行过颈总动脉结扎和开颅颈内动脉夹闭术的颈内动脉海绵窦瘘，分别采用经股动脉行颈内动脉栓塞和经眼静脉行颈内动脉海绵窦瘘栓塞治疗，取得满意效果。     

海绵窦颈内动脉损伤所致严重鼻出血的血管内栓塞…

报告海绵窦颈内动脉损伤引起严重鼻出血２例，其中１例为突入蝶窦的巨大假性动脉瘤，１例为已进行守颈总动脉结扎和开颅颈内动脉夹闭术的颈内动脉海绵窦瘘，分别采用经股动脉行颈内动脉栓塞和经眼静脉行颈内动海绵窦瘘栓塞治疗，取得满意效果。     

外伤性颈内动脉海绵窦段损伤的诊断及血管内治疗

目的总结8例外伤性颈内动脉海绵窦段损伤的诊断及血管内治疗,并分析其发病机制。方法对8例头颅外伤史伴有眼部症状或鼻出血症状,考虑颈内动脉海绵窦段损伤的患者采用Seldinger技术股动脉插管造影诊断和介入栓塞治疗。结果数字减影血管造影（digtal subtraction angiography,DSA）成像诊断颈内动脉海绵窦瘘（carotid cavernous sinus fistula,CCF）6例,颈内动脉海绵窦段假性动脉瘤2例,均成功的行介入栓塞治疗,未出现明显的并发症,无1例患者死亡。结论对有头颅外伤史伴有眼部症状或鼻出血症状的应及早行DSA造影以明确诊断。介入栓塞技术为外伤性颈内动脉海绵窦段损伤的治疗中首选的方法。     

颈内动脉假性动脉瘤致进行性单侧视力障碍1例

外伤性视神经病在闭合性颅脑外伤中的发病率约为0.5％～5％,68％～78％的患者伤后即无光感[1],同时可能出现视力障碍、脑血栓、出血等其他症状,甚至危及生命.外伤性颈内动脉假性动脉瘤是颅脑损伤后的一种罕见血管损伤并发症,多发生在颈内动脉C4海绵窦段和C2岩骨段,常因有颅底骨折而发生.     

海绵窦颈内动脉损伤致严重鼻出血三例报告

报告海绵窦颈内动脉损伤致严重鼻出血３例，其中２例假性动脉瘤，１例动静脉瘘。３例鼻出血前均有先兆症状，如头痛、脉搏增快和头面部发热。文中对海绵窦颈内动脉损伤致鼻出血的发生机理和特征进行了讨论。     

视神经减压术中蝶窦外侧壁的结构辨认和保护

目的探讨鼻内镜下视神经减压术中如何准确找到和开放视神经管,避免毗邻重要结构损伤,并介绍术中大动脉出血的紧急处理。方法确诊为外伤性视神经病的患者3 0例,术前明确视神经、颈内动脉、眼动脉的位置和损伤情况,定位彼此间的解剖关系。术中以术前的影像学资料为依据初步定位视神经的位置,采取直接开放视神经管或沿眶尖向后逐渐开放视神经管的方式减压视神经,同时注意毗邻解剖结构的保护。结果 30例均准确定位视神经管和视神经;28例顺利完成视神经减压;2例眼动脉假性动脉瘤出血,经及时窦腔填塞止血,终止视神经减压手术;无手术所致的视神经、颈内动脉、眼动脉和海绵窦损伤等严重并发症。结论以影像学资料为依据选择恰当的方法开放视神经管;注意蝶窦外侧壁结构的保护,并掌握紧急处理和预防颈内动脉和眼动脉出血的方法;是防止严重并发症和保证手术顺利完成的关键。     

外伤致颈内动脉海绵窦瘘2例

目的：进一步加强对外伤性颈内动脉海绵窦瘘的认识，做到早诊断早治疗，避免误诊。方法：对2例外伤性颈内动脉海绵窦瘘病人及时行介入性血管内栓塞治疗。结果：2例均获得满意疗效。结论：介入性血管内栓塞是治疗外伤性颈内动脉海绵窦瘘的主要和有效手段，早期诊断和及时的治疗是减少后遗症的关键。     

创伤性迟发性鼻出血与假性动脉瘤关系的临床研究

目的 探讨创伤性迟发性鼻出血的诊断和治疗方法,并提出创伤性颌面部中小动脉假性动脉瘤性鼻出血的概念.方法 回顾性总结、分析了1990年3月-2005年3月期间山东省立医院耳鼻咽喉科收治的表现为创伤性迟发性鼻出血并接受数字减影血管造影检查和治疗的53例患者的有关资料.结果 该53例患者中,颈内动脉假性动脉瘤8例,其中7例行血管栓塞治疗,6例痊愈,1例死亡;另1例未行栓塞,在行建立侧支循环功能训练时出血死亡;颈内动脉海绵窦瘘20例,均使用可脱性球囊栓塞成功;颌面部中小动脉出血25例,21例为上颌动脉和或面动脉分支出血,使用明胶海绵颗粒结合弹簧圈行血管栓塞治疗,4例筛前动脉出血者行筛前动脉结扎术.随访6～72个月,中位随访时间为5年.除1例上颌动脉栓塞者再次鼻出血外,其余患者随访期间均未再出血,未发生严重并发症.结论 颈内动脉假性动脉瘤、颈内动脉海绵窦瘘、颌面部中小动脉假性动脉瘤性鼻出血是导致创伤性迟发性鼻出血主要原因,采用数字减影血管造影技术明确诊断并进行血管内栓塞或动脉结扎是治疗该类疾病的有效办法.     

海绵窦颈内动脉损伤(附5例报告)

本文报告5例均经颈动脉造影确诊的海绵窦颈内动脉损伤的患者，其中2例假性动脉瘤，3例动静脉瘘性动脉瘤；2例反复出现严重鼻出血，3例未出现鼻出血。文中对其临床表现、诊断和治疗原则进行了讨论。认为有头部外伤史和眼部症状者，即使无鼻出血，亦应高度怀疑此病，治疗应以血管介入疗法为主，颈部血管结扎仅应是应急时的选择。     

Cavernous carotid injury during functional endoscopic sinus surgery: case presentations and guidelines for optimal management

BACKGROUND: Surgery in the parasellar and paranasal regions is technically challenging because of the complex anatomic relationships between the sphenoid sinus, cavernous sinus, optic nerve, and internal carotid artery. Normal anatomic variations and pathological changes can lead to disastrous outcomes including carotid artery injury. METHODS: We present two cases of carotid injury managed at our institution. The first case involves an elective endoscopic biopsy of a clival tumor encasing a friable carotid artery. The second case features a patient transferred emergently to our medical center when brisk bleeding was encountered during functional endoscopic sinus surgery (FESS). Both carotid injuries were managed via balloon embolization with close interaction between otolaryngology and interventional radiology. We review pertinent anatomic and surgical considerations as a backdrop to a treatment algorithm for cavernous carotid hemorrhage secondary to FESS complication. RESULTS: The treatment algorithm prevented mortality and minimized morbidity in the two cases considered. CONCLUSION: Through rare, injury to the cavernous carotid during FESS can be managed successfully given efficient hemostasis and seamless cooperation among emergency room physicians, otolaryngologists, and interventional radiologists.     

伴有颅眶并发症的蝶窦病变35例分析

目的：探讨蝶窦病变伴颅、眶并发症的临床表现及鼻内镜治疗的方法。方法：回顾分析近5年收治的蝶窦病变伴有颅、眶并发症35例患者的临床表现、诊断及手术治疗结果。结果：35例患者中并发脑膜炎5例,海绵窦血栓3例,垂体脓肿2例,颅内多发脓肿1例,球后视神经炎15例,外展神经麻痹8例,眶尖综合征2例（同时并发脑膜炎1例）;所有患者均行鼻内镜下蝶窦开放病变切除术,除1例颅内广泛感染（脑干衰竭）、2例恶性肿瘤患者死亡外,其余症状均不同程度得到缓解。结论：蝶窦病变若不及时治疗,易引起颅、眶并发症,并可导致严重后果。     

Management of traumatic facial nerve paralysis with carotid artery cavernous sinus fistula

Massive skull base injuries require detailed preoperative neurological and neurovascular assessment prior to undertaking surgical repair of isolated cranial nerve deficits. We present the management of a patient with traumatic facial paralysis, cerebrospinal fluid leak, and carotid artery cavernous sinus fistula as the result of a gunshot wound to the skull base. The carotid artery cavernous sinus fistula was ultimately controlled with superselective embolization via the vertebral artery. The facial nerve injury was then safely treated with mobilization of the labyrinthine and vertical segments to allow a primary anastomosis.     

Surgical anatomy of the optic nerve and the internal carotid artery in the lateral wall of the sphenoid sinus. An anatomic study of the cranial base]

The optic nerve and the internal carotid artery lying in the cavernous sinus contact the bony wall of the sphenoid sinus, and can easily be injured during surgery. The maxillary sinus, the sphenoid sinus and the ethmoid cells were opened on both sides during ten resections of the skull base. After removing the bony part of the lateral wall of the sphenoid sinus the following measurements were performed: the distance between the optic nerve and the frontal dura; the distance between the optic nerve and the internal carotid artery; the length and width of the optic nerve and the internal carotid artery in the area contacting the bony wall of the sphenoid sinus. This study illustrates the regularity of the structures of the posterior nasal wall. Landmarks are offered for finding the orbital aperture of the optic canal. The necessity of orientation by landmarks is emphasized.     

外伤性蝶窦内颈内动脉假性动脉瘤的诊断及治疗探讨（附6例报告）

目的：探讨外伤性蝶窦内颈内动脉假性动脉瘤的早期诊断方法,防止误诊,并选择正确的治疗方法,降低死亡率。方法：回顾性分析6例确诊为外伤性蝶窦内假性动脉瘤患者的诊断和治疗经过,并结合国内外相关文献资料,提出早期诊断方法,选择最佳治疗方案。结果：6例患者均有头部外伤病史,并有不同程度反复发作的鼻出血,2例单眼失明;6例中1例行一侧颈总动脉结扎,3例行可脱球囊闭塞动脉瘤及颈内动脉,1例行微弹簧圈栓塞颈内动脉,该5例均痊愈;1例仅反复行鼻腔填塞,因大出血死亡。结论：该病可因难已控制的鼻出血而致死,早期诊断,合理治疗可治愈。     

Traumatic internal carotid artery pseudoaneurysm mimicking sphenoid sinus tumor

Massive epistaxis following blunt craniofacial trauma should alert clinicians to possible traumatic internal carotid artery (ICA) aneurysm. This article describes a case of a 46-year-old female patient with traumatic ICA pseudoaneurysm presenting similar to a sphenoid sinus mass lesion. Massive bleeding occurred during the endoscopic procedure. Brain angiography revealed two lobulated ICA pseudoaneurysms over a cavernous segment. The patient successfully underwent endovascular stent assisted coil embolization. Timely diagnosis and treatment of the ICA psuedoaneurysm produced a favourable outcome.     

鼻源性突眼的临床分析

目的：探讨鼻源性突眼的诊断和治疗,以降低其误诊、漏诊的发生率。方法：对本院1998年1月～2005年10月62例鼻源性突眼患者进行回顾性分析。结果：62例鼻源性突眼患者中,47例首诊眼科,15例以鼻塞、头痛、鼻出血等症状首诊于耳鼻咽喉科。其中额筛囊肿18例,全组鼻窦炎12例,真菌性额窦炎6例,上颌窦癌10例,嗅神经母细胞瘤4例,外伤性颈动脉海绵窦瘘6例,筛窦骨瘤6例。全部病例均经CT、MRI或病理检查确诊。额筛囊肿、筛窦骨瘤及鼻窦炎引起的突眼患者全部治愈。上颌窦癌引起的突眼患者术后随访5年,2例健在,2例失访;嗅神经母细胞瘤引起的突眼患者术后2年均死亡;外伤性颈动脉海绵窦瘘引起的突眼患者2例死亡,4例治愈。结论：以突眼为主要表现的鼻科疾病临床上少见,临床医师对该病认识不足易致误诊、漏诊,根据造成突眼的病因,选择正确的治疗方案,可获满意治疗效果。