PDF(Pubmed)
Abstract：
UNASSIGNED: Endoscopic transnasal optic canal decompression is widely used in the treatment of traumatic optic neuropathy (TON) following head and craniofacial trauma. Intraoperative hemorrhage is a catastrophic surgical complication during optic canal decompression.
UNASSIGNED: We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery.
UNASSIGNED: The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.
UNASSIGNED: We present two cases of patients with TON who suffered unexpected intra-operative massive bleeding during endoscopic transnasal optic canal decompression. After intraoperative hemostasis was achieved, emergent cerebral angiograms demonstrated the formation of internal carotid pseudoaneurysms, which were immediately embolized with coils combined with or without Onyx with balloon assistance. One of these cases was also complicated by a postoperative cerebrospinal fluid leak, which failed to be treated with lumbar drainage but was successfully repaired with endoscopic transnasal surgery.
UNASSIGNED: The intra-operative rupture of ICA pseudoaneurysm is a rare but catastrophic complication in TON patients. Intraoperative massive bleeding indicates rupture of ICA pseudoaneurysm. Postoperative emergency angiography and endovascular therapy should be arranged to evaluate and repair the cerebral vascular injury. Endoscopic trans-nasal surgery repairing CSF leaks resistant to lumbar drainage could be efficient and safe following pseudoaneurysm embolization.
摘要：
■经鼻内窥镜视神经管减压术广泛用于治疗头和颅面部外伤后的外伤性视神经病变（TON）。术中出血是视神经管减压期间的灾难性手术并发症。
■我们介绍了两例TON患者，他们在内窥镜经鼻视神经管减压术中意外出现术中大出血。术中止血后，急诊脑血管造影显示颈内动脉假性动脉瘤的形成，立即用带有或不带有Onyx的线圈在球囊辅助下栓塞。其中一例还因术后脑脊液漏而复杂化，腰椎引流治疗失败，但经鼻内镜手术成功修复。
■术中破裂的ICA假性动脉瘤在TON患者中是一种罕见但灾难性的并发症。术中大量出血提示ICA假性动脉瘤破裂。术后应安排急诊血管造影和血管内治疗，以评估和修复脑血管损伤。在假性动脉瘤栓塞后，内镜经鼻手术修复抗腰椎引流的CSF渗漏可能是有效且安全的。
■我们介绍了两例TON患者，他们在内窥镜经鼻视神经管减压术中意外出现术中大出血。术中止血后，急诊脑血管造影显示颈内动脉假性动脉瘤的形成，立即用带有或不带有Onyx的线圈在球囊辅助下栓塞。其中一例还因术后脑脊液漏而复杂化，腰椎引流治疗失败，但经鼻内镜手术成功修复。
■术中破裂的ICA假性动脉瘤在TON患者中是一种罕见但灾难性的并发症。术中大量出血提示ICA假性动脉瘤破裂。术后应安排急诊血管造影和血管内治疗，以评估和修复脑血管损伤。在假性动脉瘤栓塞后，内镜经鼻手术修复抗腰椎引流的CSF渗漏可能是有效且安全的。
