title: Cerebrovascular complications of transorbital penetrating intracranial injuries.
abstract: BACKGROUND
  Cerebrovascular trauma secondary to transorbital intracranial penetrating injury (TIPVI) is rare. Relatively benign initial presentation may mask the underlying life-threatening vascular injury in transorbital intracranial penetrations. The aim of this study was to evaluate clinical features and endovascular treatment of TIPVI.
  
  
  METHODS
  Six patients with angiographic documentation of TIPVI in subacute/chronic phase were reviewed retrospectively. Five were treated endovascularly; however endovascular treatment was aborted in one and conservative management was pursued.
  
  
  RESULTS
  Except for one case presenting with vision loss and mild stroke, no significant neurologic deficit was present. Vascular lesions included two cases of carotid-cavernous fistulas, three traumatic aneurysms of cavernous carotid, anterior and middle cerebral arteries and a unique case of coalescing cavernous aneurysms following a through-and-through injury in which the aneurysms united within the thrombosed cavernous sinus on follow up. Fistulas were treated with covered stents, aneurysms with parent artery occlusion or flow diverters. All patients had uneventful recoveries.
  
  
  CONCLUSIONS
  TIPVI may present in a delayed fashion after a seemingly benign presentation. A high index of suspicion is critical to rule out TIPVI with vascular imaging. Transcatheter angiographic techniques allow for both diagnosis and treatment of TIPVI with favorable results.
authors.affiliation: Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey; Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
authors.forename: Yonca
authors.initials: Y
authors.lastname: Özkan Arat
authors.affiliation: Department of Radiology, Section of Interventional Neuroradiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Anıl
authors.initials: A
authors.lastname: Arat
authors.affiliation: Department of Radiology, Section of Interventional Neuroradiology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey.
authors.forename: Kubilay
authors.initials: K
authors.lastname: Aydın
mesh_terms: D000293:Adolescent; D000328:Adult; D002533:Cerebral Angiography; D002675:Child, Preschool; D057510:Endovascular Procedures; D015807:Eye Injuries, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D020197:Head Injuries, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*