Management of Traumatic Cerebral Aneurysms

Choi, Byung Yon

Abstract

Owing to their rarity and the preferential use of CT scanning in the evaluation of trauma cases, the diagnosis of traumatic aneurysms is usually missed. Because the lesion are mostly false aneurysm resulting from injury to all vascular layer, about 90% of this lesion bleed within first 3 weeks after trauma and one-half of the patients who experience this bleeding die; therefore, early diagnosis and treatment are the most essential. The diagnosis requires a high index of suspicion and subsequent angiography. The diagnosis needs to be entertained in any patient who deteriorates by delayed cerebral hemorrhage in the period after severe closed or penetrating head injury. Angiographically, traumatic aneurysms usually have poorly defined necks, are not usually at bifurcation sites, are irregular shaped, and have delayed filling and emptying of sac. Traumatic aneurysm tend to increase in size, therefore immediate surgical exclusion is recommended. Current alternative treatment of traumatic aneurysms involves occlusion of the main artery through the use of endovascular techniques, with either detachable balloons or GDC. In intolerable case to occlusion test, it need EC-IC bypass surgery before occlusion. Surgery is a treatment of choice for traumatic aneurysms in distal locations. The outcome seems to depend on severity of the initial head injury.