[Angiography of the carotid artery in centro-lateral skull base fractures?].
BACKGROUND
In latero-basal, central or spheno-fronto-orbital skull base fractures the internal carotid artery is more frequently involved in severe lesions than expected.


METHODS
Between 1996 and 2003 we examined 684 patients with Glasgow Coma Scales (GCS) between 2 and 15, median 7.2, using computed tomography (CT). In suspicion of a latero-basal, central or spheno-fronto-orbital fractur they got an additional high resolution skull base CT. If the bony canal of the internal carotid artery (ICA) was involved the patient underwent digital subtraction angiography (DSA). The ICA lesion was treated either interventional neuroradiologically, by surgery or only conservatively.


RESULTS
Of the 684 patients 33 (4.8 %) had fractures of the ICA bony canal and therefore underwent DSA. Among them were 25 men and 8 women (mean age 35.3 years). Lesions of the ICA were seen in 1.9 % of the patients. A traumatic cavernous-carotid fistula was found in 7 patients (1 %) and in 6 patients (0.9 %) a dissection and/or an aneurysm of the ICA was diagnosed. Six of the patients had clinical symptoms. The lesions were treated primarily interventional neuroradiologically (n = 5) as well as surgically in two cases by clipping the aneurysm and closing the sphenoid sinus, respectively.


CONCLUSIONS
Vessel lesions of the ICA in skull base fractures and involvement of the bony carotid canal are more frequent than mentioned in current literature. A solid diagnosis can only be achieved by DSA. Early diagnosis and treatment is important for improving the prognosis of these often multiply injured patients.
Steigerwald
C
C
Universitätsklinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Albert-Ludwigs-Universität Freiburg.
Draf
W
W
Hofmann
E
E
Minovi
A
A
Behr
R
R
Bockmühl
U
U
D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000601:surgery; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D009917:Orbital Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D019291:Skull Base / Q000293:injuries* / Q000601:surgery; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed