弹片穿透致重型颅脑损伤合并创伤性颅内动脉瘤1例及文献复习

潘源; 闫亚洲; 荆洁; 卢佩林; 于召虎; 王宇; 迟玉祥; 吴泳; 荆文慧; 辛涛

doi:10.16016/j.2097-0927.202204028

您当前的位置：

首页 >

文章列表页 >

弹片穿透致重型颅脑损伤合并创伤性颅内动脉瘤1例及文献复习

临床医学 | 更新时间：2026-01-09

- 弹片穿透致重型颅脑损伤合并创伤性颅内动脉瘤1例及文献复习
- Traumatic intracranial aneurysm in blast penetrating brain injury: 1 case report and literature review
- 陆军军医大学学报 2022年44卷第21期页码：2224-2228
- 作者机构：
  
  266071 山东青岛，解放军第九七一医院神经外科
- 作者简介：
  
  [辛涛，E-mail: xtdlcc@hotmail.com XIN Tao, E-mail: xtdlcc@hotmail.com
- 基金信息：
  
  青岛市科技惠民示范引导专项(22-3-7-smjk-3-nsh)
- DOI：10.16016/j.2097-0927.202204028
  中图分类号： R651.15;R732.21;R826.62
- 收稿：2022-04-03，
  
  修回：2022-06-12，
  
  纸质出版：2022-11-15
- 稿件说明：
移动端阅览
潘源, 闫亚洲, 荆洁, 等. 弹片穿透致重型颅脑损伤合并创伤性颅内动脉瘤1例及文献复习[J]. 陆军军医大学学报, 2022,44(21):2224-2228.

Yuan PAN, Yazhou YAN, Jie JING, et al. Traumatic intracranial aneurysm in blast penetrating brain injury: 1 case report and literature review[J]. Journal of Army Medical University, 2022, 44(21): 2224-2228.
潘源, 闫亚洲, 荆洁, 等. 弹片穿透致重型颅脑损伤合并创伤性颅内动脉瘤1例及文献复习[J]. 陆军军医大学学报, 2022,44(21):2224-2228. DOI： 10.16016/j.2097-0927.202204028.

Yuan PAN, Yazhou YAN, Jie JING, et al. Traumatic intracranial aneurysm in blast penetrating brain injury: 1 case report and literature review[J]. Journal of Army Medical University, 2022, 44(21): 2224-2228. DOI： 10.16016/j.2097-0927.202204028.

摘要

目的

分析1例流弹爆炸伤致重型颅脑损伤合并创伤性颅内动脉瘤患者的救治经验并复习相关文献。

方法

2020年12月我科收治1例流弹爆炸致重型颅脑外伤患者，急诊行气管切开术+脑室外引流术，伤后第2天CTA检查发现左侧胼周动脉形成断端，约有2 mm的盲端增粗，未见假性动脉瘤瘤体、瘤腔形成；伤后第7天因脑水肿脑疝形成，行右侧开颅去骨瓣减压、伤道探查清创、坏死脑组织清除术；伤后第17天假性动脉瘤出血，经介入方法栓塞动脉瘤及载瘤动脉。

结果

患者伤后第44天恢复意识，可遵嘱闭眼伸指，3个月后格拉斯哥昏迷评分(GCS)15分，语言正常，拔除气管套管，正常进食，右侧肢体肌力5级，肌张力正常，左侧肢体偏瘫；临床随访12个月动脉瘤无复发出血。

结论

颅脑弹片穿透伤后脑水肿较重，需要早期减压手术；弹片穿透脑组织后会引起颅内假性动脉瘤，需要尽早筛查处理，避免发生迟发性大出血。

Abstract

Objective

To analyze our treatment experience of a case of traumatic intracranial aneurysm complicated with blast penetrating brain injury.

Methods

A case of traumatic brain injury (TBI) wounded by shrapnel was admitted in our department in December 2020. We performed emergency tracheostomy and external ventricular drainage. Computed tomography angiogram (CTA) on the second day after injury revealed a left-sided pericallosal artery forming stump with approximately 2 mm of blind end thickening

no pseudoaneurysm bodies

or aneurysm cavity formation. On the 7th day

because of the refractory cerebral edema

we performed right side craniotomy and cleared the necrotic brain tissue. The pseudoaneurysm hemorrhaged on day 17 after injury

and the aneurysm and the parent artery were embolized by interventional methods.

Results

The patient regained consciousness on the 44th day after injury and could follow instructions. Three months later he had a Glasgow coma scale (GCS) score of 15 with left limb hemiparesis. There were no recurrences of the aneurysm during 12 months of clinical follow-up.

Conclusion

Severe brain edema after penetrating shrapnel injuries often requires early decompression. Intracranial tarumatic aneurysms can arise after shrapnel penetrates

and require early screening management.

关键词

Keywords

references

KAPUR G B, HUTSON H R, DAVIS M A, et al . The United States twenty-year experience with bombing incidents: implications for terrorism preparedness and medical response[J ] . J Trauma, 2005, 59(6): 1436-1444. DOI: 10.1097/01.ta.0000197853.49084.3c.

BOCHICCHIO G V, LUMPKINS K, O'CONNOR J, et al . Blast injury in a civilian trauma setting is associated with a delay in diagnosis of traumatic brain injury[J ] . Am Surg, 2008, 74(3): 267-270.

JITHOO R, GOVENDER S T, NATHOO N. Penetrating nail Gun injury of the head and chest with incidental pericallosal artery aneurysm[J]. Suid Afrikaanse Tydskrif Vir Geneeskunde, 2001, 91(4): 316-317.

HOROWITZ M B, KOPITNIK T A, LANDRENEAU F, et al . Multidisciplinary approach to traumatic intracranial aneurysms secondary to shotgun and handgun wounds[J ] . Surg Neurol, 1999, 51(1): 31-42. DOI: 10.1016/s0090-3019(98)00029-9.

DENG Q, FENG W F. Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms[J]. J Interv Med, 2020, 3(1): 45-48. DOI: 10.1016/j.jimed.2020.01.007.

Vascular complications of penetrating brain injury[J]. J Trauma, 2001, 51(2 Suppl): S26-S28.

AARABI B. Traumatic aneurysms of brain due to high velocity missile head wounds[J]. Neurosurgery, 1988, 22(6 Pt 1): 1056-1063. DOI: 10.1227/00006123-198806010-00014.

APPELBAUM R D, NERI K E, REBO K A, et al . Penetrating brain injury with hypopituitarism[J ] . Trauma Case Rep, 2022, 38: 100628. DOI: 10.1016/j.tcr.2022.100628.

MANSOUR A, LOGGINI A, EL AMMAR F, et al . Cerebrovascular complications in early survivors of civilian penetrating brain injury[J ] . Neurocrit Care, 2021, 34(3): 918-926. DOI: 10.1007/s12028-020-01106-y.

曾而明, 徐春华, 洪涛. 创伤性脑血管损伤的研究进展[J]. 中华神经外科杂志, 2016, 32(9): 969-972. DOI: 10.3760/cma.j.issn.1001-2346.2016.09.027.

ZENG E M, XU C H, HONG T. Advances in traumatic cerebrovascular injury[J]. Chin J Neurosurg, 2016, 32(9): 969-972. DOI: 10.3760/cma.j.issn.1001-2346.2016.09.027.

AKBIK O S, VORONOVICH Z A, CARLSON A P. Treatment of unusually located traumatic intracranial aneurysms and severe vasospasm following a gunshot wound to the head: a case report[J]. Surg Neurol Int, 2020, 11: 57. DOI: 10.25259/SNI_573_2019.

JUNG S H, KIM S H, KIM T S, et al . Surgical treatment of traumatic intracranial aneurysms: experiences at a single center over 30 years[J ] . World Neurosurg, 2017, 98: 243-250. DOI: 10.1016/j.wneu.2016.11.005.

BHAISORA K S, BEHARI S, GODBOLE C, et al . Traumatic aneurysms of the intracranial and cervical vessels: a review[J ] . Neurol India, 2016, 64(Suppl): S14-S23. DOI: 10.4103/0028-3886.178032.

TAKAHASHI C E, VIRMANI D, CHUNG D Y, et al . Blunt and penetrating severe traumatic brain injury[J ] . Neurol Clin, 2021, 39(2): 443-469. DOI: 10.1016/j.ncl.2021.02.009.

ESNAULT P, ROUBIN J, CARDINALE M, et al . Spontaneous hyperventilation in severe traumatic brain injury: incidence and association with poor neurological outcome[J ] . Neurocrit Care, 2019, 30(2): 405-413. DOI:10.1007/s12028-018-0639-0.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

促红细胞生成素及其受体在脑外伤后的表达及意义