外傷性内頸動脈動脈瘤—特に大量鼻出血をきたした症例とその治療法について

TRAUMATIC ANEURYSM OF THE EXTRADURAL PORTION OF THE INTERNAL CAROTID ARTERY:REPORT OF FOUR CASES

I．緒言

　顔面，あるいは頭部の外傷直後鼻出血をきたす例は多いが，大部分の症例が鼻粘膜の損傷，前論骨動脈，蝶口蓋動脈などの側枝の断裂に原因するもので，止血は一般に容易である。

　銃弾創，あるいは傘の柄，編み棒などによる穿通創で，直接内頸動脈壁が損傷され，これより仮性動脈瘤を生じ，蝶骨洞に破れて，大量鼻出血をきたしたという症例も報告されている。

(1) Four cases of traumatic aneurysm of the internal carotid artery at the skull base have been presented and the available literature has been reviewed. In 3 cases, a massive epistaxis recurred secondary to the rupture of the aneurysm into the paranasal sinuses. In the remaining one, no ep-istaxis occurred, but the carotid-cavernous sinus fis-tula was associated with the aneurysm and both were followed up by repeated angiographies over several months.

(2) Fracture of the base of the skull, monocular blindness and recurrent severe epistaxis of late onset following closed head injury, strongly indicate the traumatic aneurysm of the internal carotid artery at the base of the skull.

(3) Surgical treatment has been briefly discussed. The importance of angiographic evaluation of the collateral circulation and of the " one-stage proce-dure " for complete interruption of blood flow into the aneurysm has been stressed.