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Published on: August 11, 2015
Neuroendovascular Surgery Applications in Craniocervical Trauma
Michael Kim1, Galadu Subah1, Jared Cooper1
1Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA.
Insights
Neuroendovascular techniques offer diverse options for treating cerebrovascular injuries from head and neck trauma, including dissections and fistulas. These minimally invasive methods provide valuable alternatives when traditional surgery is not feasible.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Radiology
Background:
- Cerebrovascular injuries from blunt or penetrating head and neck trauma can cause hemorrhage and stroke.
- Manifestations include arterial dissection, pseudoaneurysm, occlusion, fistula, epistaxis, venous sinus thrombosis, and subdural hematoma.
Purpose of the Study:
- To review neuroendovascular surgical techniques for craniocervical trauma.
- To explore the evolving landscape of endovascular treatments for traumatic cerebrovascular injuries.
Main Methods:
- Selective literature review (1989-2023) using PubMed.
- Keywords included endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, fistula, epistaxis, and embolization techniques.
Main Results:
- A growing number of neuroendovascular procedures are available for traumatic cerebrovascular injuries.
- Techniques include embolization (coils, liquid agents, particles), stenting, mechanical thrombectomy, and balloon occlusion tests.
Conclusions:
- Neuroendovascular techniques are valuable adjuncts, especially when surgical options are limited.
- Further research is needed to compare endovascular and surgical outcomes in trauma cases.
Abstract:
Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.
