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Traumatic intracranial aneurysms due to blunt brain injury—a single center experience

  • Clinical Article
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Abstract

Background

Traumatic intracranial aneurysms (TICAs) have previously been described in literature. However, the evidence of TICAs secondary to blunt brain injury have not been elucidated well, with most of the conclusions coming from isolated case reports. We have attempted to examine the epidemiology, classification, clinical presentation, therapeutic modalities, and outcomes of TICAs with our series of patients at the neurosurgery department of Xuanwu Hospital, China.

Methods

We reviewed our aneurysm database from January 1, 2005 to December 31, 2011. In particular, patients with TICAs secondary to blunt brain injury were reviewed. Variables assessed included age, sex, causes of blunt brain injury, skull fracture, location, classification, clinical presentation, time elapsed to arrive at diagnoses, treatment, and eventual outcome. Based on our assessment, we arrived at a modified classification scheme to categorize these aneurysms.

Results

We reviewed 2335 patients with cerebral aneurysm from January 1, 2005 to December 31, 2011. Of these, 15 patients (0.64 %) with traumatic aneurysms secondary to blunt brain injury were identified.Motor vehicle accidents (MVA) were observed to be the most common cause of injury (10 patients, 66.7 %), followed by TICAs sustained after falling down (5 patients, 33.3 %). The most common symptom at presentation was epistaxis (6 patients, 40 %), followed by ophthalmic problems (6 patients, 40 %), with both presentations seen in 1 patient. The most common diagnostic modality used was DSA in 12 patients (80 %) followed by CTA in 2 patients (13.3 %). Infraclinoid TICAs were seen in 9 patients (60 %), whereas supraclinoid TICAs were seen in 5 patients (33.3 %), with perifalx TICAs seen in 1 patient. Endovascular intervention therapies were performed in 11 patients (73.3 %), bypass surgery and trapping in 2 (13.3 %), transnasal endoscopic approach in combination with balloon assisted in 2 patients. At discharge, 2 patients had poor clinical outcomes (13.3 %), 5 had fair (33.3 %),and 8 resulted with good outcomes (53.3 %).

Conclusions

TICAs arising secondary to blunt brain injury account for 0.64 % of all cerebral aneurysms. Infraclinoid, supraclinoid ICA and perifalx TICAs are the most common aneurysms arising from blunt brain injury. Our study further shows that traumatic patients presenting with recurrent epistaxis, oculomotor nerve palsy, and delayed intracranial hemorrhage should receive cerebroangiography as soon as possible. An early diagnosis and proper treatment could prove to be helpful in terms of improving final clinical outcome.

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Conflicts of interest

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Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Zip code 100053, Beijing, People’s Republic of China

    Zhiqi Mao, Ning Wang, Meng Li, Hongqi Zhang, Qiuhang Zhang, Peng Zhang, Xinglong Zhi & Feng Ling

  2. Department of Neurosurgery, Wayne State University, Detroit, MI, USA

    Mohammed Hussain

Authors
  1. Zhiqi Mao
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  2. Ning Wang
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  3. Mohammed Hussain
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  4. Meng Li
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  5. Hongqi Zhang
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  6. Qiuhang Zhang
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  7. Peng Zhang
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  8. Xinglong Zhi
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  9. Feng Ling
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Correspondence to Feng Ling.

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Comment

In our series of 114 pediatric patients in 1937–2009 with intracranial aneurysms (1), 10 had TICAs, most of which were unruptured and occurred due to traffic accidents in the 60’s - 70’s. Out of the 10 aneurysms, three ruptured after a median of 2 weeks after the trauma, and one presented with epistaxis. All these patients were studied at that time with conventional angiography due to the lack of a CT scan. Since then, probably due to better traffic safety, the number of diagnosed TICAs has decreased considerably in all age groups. However, we may miss some, as we do not routinely perform cerebral angiographies in blunt head trauma patients unless there is a strong clinical suspicion of SAH prior to trauma. Nowadays, when indicated, this would be very easy and quick with non-invasive 4-vessel imaging techniques (CTA).

1. Koroknay-Pál P, Lehto H, Niemelä M, Kivisaari R, Hernesniemi J. Long-term outcome of 114 children with cerebral aneurysms. J Neurosurg Pediatrics 9:636–645, 2012

Mika Niemelä

Päivi Koroknay-Pál

Juha Hernesniemi

Helsinki, Finland

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Mao, Z., Wang, N., Hussain, M. et al. Traumatic intracranial aneurysms due to blunt brain injury—a single center experience. Acta Neurochir 154, 2187–2193 (2012). https://doi.org/10.1007/s00701-012-1487-x

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