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.     

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。     

颈内动脉虹吸段完全性栓塞治疗创伤性假性动脉瘤

目的　通过数字减影血管造影 (digitalsubtractionangiography ,DSA)技术诊断颅脑外伤所致的颈内动脉 (internalcarotidartery ,ICA)虹吸段假性动脉瘤。方法　对颅脑外伤合并严重鼻出血的患者进行DSA造影 ,筛选出虹吸段ICA假性动脉瘤 6例 ,经脑动脉环侧支循环功能检测 ,对功能良好者进行ICA虹吸段完全性栓塞。结果　 6例经DSA明确诊断为ICA假性动脉瘤 ,5例进行了动脉栓塞 ,其中 4例痊愈 ,1例死亡 ;另 1例脑动脉环侧支循环功能不良 ,未行栓塞 ,行改善侧支循环功能训练时鼻出血死亡。结论　经DSA明确诊断的颈内动脉假性动脉瘤 ,经脑动脉环侧支循环筛选后 ,可行虹吸段颈内动脉完全性栓塞治疗     

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。     

颈内动脉虹吸段完全性栓塞治疗创伤性假性动脉瘤

目的：通过数字减影血管造影（digital subtraction angiography,DSA)技术诊断颅脑外伤所致的颈内动脉（internal carotid artery,ICA)虹吸段假性动脉瘤。方法：对颅脑外伤合并严重鼻出血的患者进行DSA造影，筛选出虹吸段ICA假性动脉瘤6例，经脑动脉环侧支循环功能检测，对功能良好者进行ICA虹吸段完全性栓塞。结果：6例经DSA明确诊断为ICA假性动脉瘤，5例进行了动脉栓塞，其中4例痊愈，1例死亡；另1例脑动脉环侧支循环功能不良，未行栓塞，行改善侧支循环功能训练时鼻出血死亡。结论：经DSA明确诊断的颈内动脉假性动脉瘤，经脑动脉环侧支循环筛选后，可行虹吸段颈内动脉完全性栓塞治疗。     

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。     

头颈部血管性疾病的介入诊治

目的:评价介入诊疗技术在头颈部血管性疾病中的诊断和治疗价值。方法:对采用Seldinger技术动脉插管造影、栓塞进行诊断和治疗的鼻咽纤维血管瘤、外伤性颈内动脉海绵窦瘘、头面部血管瘤、难治性鼻出血等32例进行回顾性分析。结果:32例数字减影血管造影 (DSA)成像中,除6例血管瘤无显影,2例腭、颈部肿块明确为颈内动脉瘤而瘤体与颈内动脉共壁无法栓塞之外,其余24例均成功进行了栓塞治疗。栓塞作为单一治疗方式的11例中,颈内动脉海绵窦瘘1 例、难治性鼻出血5例、蔓状血管瘤4例均一次栓塞治愈,1例Ⅲ期鼻咽纤维血管瘤姑息性栓塞控制了症状;栓塞辅以手术治疗的13 例,术中出血量明显减少,其中6例鼻咽纤维血管瘤,术中平均出血量为260ml,7例血管瘤术中平均出血量为150ml。结论:DSA造影在头颈部血管性病变中能显示供血动脉、异常交通支、动静脉瘘等清晰的动态图像,指导临床治疗方法的选择;血管内栓塞治疗对颈外动脉系统的难治性鼻出血、颈内动脉海绵窦瘘、部分血管瘤显示出良好的治疗效果;对血运丰富的肿瘤,术前栓塞可显著减少术中出血, 大大提高手术的安全性。图2参5     

头颈部血管性疾病的介入诊治

目的评价介入诊疗技术在头颈部血管性疾病中的诊断和治疗价值。方法对采用Seldinger技术动脉插管造影、栓塞进行诊断和治疗的鼻咽纤维血管瘤、外伤性颈内动脉海绵窦瘘、头面部血管瘤、难治性鼻出血等32例进行回顾性分析。结果32例数字减影血管造影(DSA)成像中,除6例血管瘤无显影,2例腭、颈部肿块明确为颈内动脉瘤而瘤体与颈内动脉共壁无法栓塞之外,其余24例均成功进行了栓塞治疗。栓塞作为单一治疗方式的11例中,颈内动脉海绵窦瘘1例、难治性鼻出血5例、蔓状血管瘤4例均一次栓塞治愈,1例Ⅲ期鼻咽纤维血管瘤姑息性栓塞控制了症状;栓塞辅以手术治疗的13例,术中出血量明显减少,其中6例鼻咽纤维血管瘤,术中平均出血量为260ml,7例血管瘤术中平均出血量为150ml。结论DSA造影在头颈部血管性病变中能显示供血动脉、异常交通支、动静脉瘘等清晰的动态图像,指导临床治疗方法的选择;血管内栓塞治疗对颈外动脉系统的难治性鼻出血、颈内动脉海绵窦瘘、部分血管瘤显示出良好的治疗效果;对血运丰富的肿瘤,术前栓塞可显著减少术中出血,大大提高手术的安全性。     

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。     

Interventionai Diagnosis and Treatment of Vasculogeneic Pulsatile Tinnitus

Objective To retrospectively study clinical features and diagnostic imaging of vasculogeneic pulsatile tin-nitus, and the feasibility and efficacy of transvascular interventional treatment for this condition. Methods Data from 82 cases of arterial or venous pulsatile tinnitus were reviewed. DSA characteristics and possible pathophysiological mechanisms of pulsatile tinnitus in these cases were studied. Diagnoses in this group in-cluded intracranial arterovenous fistula (AVF) (n=3), spontaneous skull base dural AVF (n=16), traumatic ca-rotid-cavernous sinus fistula (n=5), subclavian artery stenosis (n=2), internal carotid artery stenosis (n=3), in-tracranial arterial stenosis (n=1), kinked and/or elongated vertebrobasilar artery (n=2), venous sinus divertic-ulum (n=2), venous sinus stenosis on the dominant drainage side (n=46) and occipital sinus stenosis (n=2). Treatments included embolization and stenting using coils, NBCA glue, Balt balloons, self-expansion stents and intracranial micro-stents via either the femoral artery or femoral vein. Results Procedures were suc-cessful in all cases with no surgery-related complications. Tinnitus disappeared within 2 days after the pro-cedure in all cases. Follow up duration was 5-36 months. Recurrence occurred in 4 cases of arterial tinnitus within 3 months following the initial procedure, which improved after revision embolization or symptom management. There was no recurrence in venous tinnitus cases following stent plastic or stent-coiling embo-lization treatments. Conclusions Endovascular intervention provides a new approach to the diagnosis and treatment of intractable pulsatile tinnitus. It is also effective in differentiating and studying other types of tinnitus.     

Massive posterior epistaxis. A manifestation of internal carotid injury at the skull base

Severe crushing head injuries can produce massive posterior epistaxis as a result of injury to the internal carotid artery at the skull base. We describe two such cases with traumatic pseudoaneurysm of the internal carotid therapy. They were managed with detachable balloon embolization. The anatomy of the internal carotid artery is reviewed. The diagnosis of pseudoaneurysms and their incidence, clinical presentation, and management are discussed.     

Tinnitus caused by traumatic posterior auricular artery--internal jugular vein fistula

A patient with an arteriovenous fistula that developed after a traffic accident was recently treated. The patient noticed pulsatile tinnitus in the right orbital region two months after the accident. On the first visit, the preliminary clinical impression of this case was a carotid-cavernous fistula, but angiography showed a fistula between the posterior auricular artery and the internal jugular vein. Although rare, this arteriovenous fistula should be included in the differential diagnosis of pusatile tinnitus in the orbit region. The fistula was controlled by embolization with a platinum coil. This is the first report of an arteriovenous fistula between the posterior auricular artery and internal jugular vein.     

颅底颈内动脉瘤15例临床分析

目的探讨颅底颈内动脉瘤的诊断和临床特点。方法收集山东第一医科大学附属省立医院1995—2017年接受数字减影血管造影(DSA)或CT血管造影(CTA)检查确诊的15例颅底颈内动脉瘤患者的临床资料进行分析。15例患者中男12例,女3例;年龄17~67岁,中位年龄44岁。15例患者中DSA确诊13例,CTA确诊2例;首发症状为鼻出血的假性动脉瘤13例,其中有明确的头面部外伤史8例,颅底肿瘤放疗史5例;头痛伴颅神经障碍的真性动脉瘤2例。15例患者采用栓塞和/或手术修复等治疗,所有患者治疗后随访2~12年,观察患者是否治愈及存活状态。结果 8例外伤史患者中5例行血管栓塞治疗痊愈;2例患者未行血管栓塞,之后因大量鼻出血死亡;1例血管栓塞术后出现进行性脑梗死,之后死亡。5例颅底肿瘤放疗后患者,1例行血管栓塞后脑梗死,之后死亡;2例行血管栓塞后因原发肿瘤复发侵及颅内,于院外死亡;1例行血管栓塞联合手术治疗恢复良好;1例放弃治疗,院外大出血死亡。首诊为头痛的2例患者,1例误行手术致鼻出血后于院外行血管栓塞治疗;1例因个人原因放弃治疗死亡。总计院内死亡4例,院外死亡4例,生存7例。结论颈内动脉瘤是颅底病变中的高危疾病,伴有外伤、放疗史的鼻出血及头痛伴颅神经障碍的患者应考虑颈内动脉瘤可能,需行DSA、CTA检查进行确诊。耳鼻咽喉科医生正确诊断与治疗对患者预后至关重要。     

Nontraumatic and postirradiated intracavernous carotid hemorrhage: an unusual case of epistaxis and review of the literature

Intracavernous carotid hemorrhage is a rare cause of epistaxis. We present a case of epistaxis caused by postradiotherapy and nontraumatic cavernous internal carotid artery (ICA) hemorrhage. An 80-year-old man was admitted to our hospital with a one week history of recurrent left-sided epistaxis and a past history of radiotherapy after radical maxillectomy. Emergent angiography revealed a leak in the cavernous segment of the ICA and subsequent detachable balloon occlusion embolization of the left internal carotid artery was performed without sequelae. We conclude that carotid artery hemorrhage must be considered in the differential diagnosis of profuse and recurrent epistaxis, especially for patients after craniofacial radiotherapy. ICA embolization is the definitive treatment provided cross circulation is adequate.     

Posttraumatic internal carotid aneurysm presenting as a nasal sinus lesion

We report a case of an asymptomatic posttraumatic aneurysm of the internal carotid artery presenting in the sphenoidal and ethmoidal sinuses. Our initial clinical and radiographic diagnosis indicated a mucocele. There were two reasons for this. First, Maurer's triad of traumatic internal carotid aneurysm was not seen, since neither epistaxis nor visual disorder was present, and fracture was not evident on tomography or computed tomographic scans. Second, no symptoms or abnormalities were found in the sequential neurosurgical evaluations for a period of about six years after the head trauma. The successful results we have obtained in this case are attributable to localization by intraoperative arteriography and to hemostasis by electrothrombotic coagulation within the aneurysm alone, preserving internal carotid artery flow. A high index of suspicion preoperatively, with arteriography as indicated, may facilitate management of these cases, which are likely to become more frequent as medical advances produce more survivors of major head trauma.