外傷性頭頚部血管障害のガイドライン

─病態，診断および治療法に関して─

抄録

Angiography has become a rarely used tool in the initial stage of diagnosis and treatment of traumatic brain injury (TBI) since the advent of CT scan, which has overwhelming ability in this setting. Because of this declination of angio­graphy from the first choice tool in the treatment of TBI, it sometimes became difficult to diagnose traumatic vascular disorders (TVD) in the head and the neck in the early stage of TBI. On the other hand, development of 3-dimensional CT angiography (3D-CTA) and MR angiography (MRA) have made it possible to screen TVD less invasively. Any of those image examinations is recommended to be done in case with a strong probability of TVD in the head and the neck as follows: i) neurological condition difficult to be explained only by TBI, ii) delayed and newly-developed neurological symptoms, iii) newly-developed hemorrhage or infarction on CT or MRI, iv) neck injuries (fracture in the cervical vertebra, hyperextension or hyper-rotation of the neck, etc.), v) cranial base fracture (bleeding from the nasal cavity or external auditory meatus, etc.), vi) thick, diffuse, severe subarachnoid hemorrhage or localized intense sub­arachnoid hemorrhage. Treatment is indicated when bleed­ing or non-bleeding TVD are detected and should be per­formed as soon as possible. Cerebral angiography is still being the gold standard technique because the entire vas­cular system from cervical to intracranial area can be examined in a single examination, and also it enables immediate endovascular treatment to be initiated. As for type of ves­sel injury, TVD comprise vascular rupture, arterial occlusion, sinus thrombosis, tramuatic aneurysm, arteriovenous fistula, and cerebral vasospasm after traumatic subarachnoid hemorrhage. In this manuscript, details of pathogenesis, symptoms and treatment are discussed with representative cases.