gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Detection of blunt craniocervical vessel injuries in cervical spine injuries: the role of CT Angiography

Meeting Abstract

  • S. Fleck - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • S. Langner - Institut für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Greifswald
  • J. Baldauf - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald
  • M. Kirsch - Institut für Diagnostische Radiologie und Neuroradiologie, Universitätsklinikum Greifswald
  • H.W.S. Schroeder - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Greifswald

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.06-03

DOI: 10.3205/09dgnc146, URN: urn:nbn:de:0183-09dgnc1462

Published: May 20, 2009

© 2009 Fleck et al.
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Outline

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Objective: The awareness and detection rate of blunt craniocervical artery injuries increased over the last years. These injuries are often associated with cervical spine trauma.

The purpose of this prospective study was to determine the frequency and injury characteristics of blunt craniocervical artery injuries in patients suffering from cervical spine injuries by using a standardized CT angiography (CTA) protocol of the craniocervical vessels.

Methods: 730 consecutive patients (February 1, 2006 to September 30, 2008) requiring a whole body trauma CT due to the suspected mechanism of their injury and injury patterns were analyzed prospectively. All examinations were performed using a 16-row multi slice computed tomography (MSCT) (Sensation 16, Siemens, Erlangen).

Initially a spiral scan of the neurocranium was acquired.

Then a CT angiography of the craniocervical vessels with 40ml of iodinated contrast agent (flow 4ml/s; 40ml saline flush, flow 4ml/s) was performed starting at the level of Th2 up to the roof of the lateral ventricles (100kV, 120mAs, collimation 16x0.75, bolus tracking). Finally a contrast-enhanced spiral thoracoabdominal scan was performed after administering a second contrast bolus of 60 ml.

Besides, patients with detected isolated cervical spine injury or suspected trauma mechanism, who were not initially involved in the whole body trauma imaging protocol underwent a CT angiography with 60 ml of contrast agent. The craniocervical vessels were analyzed in the source images, maximum intensity projections (MIP) and curved multi planar reconstructions (MPR).

Results: The CTA was considered adequate for diagnosis in all but three cases. In one patient Duplex Ultrasound instead of CTA was performed due to pregnancy.

The overall incidence of blunt craniocervical artery injury in 53 patients with detected cervical spine injury was 30.2% (16 vessel lesions in 10 patients).

Conclusions: Craniocervical vessel injury is a life threatening and under-diagnosed event in case of cervical spine injury. The CTA offers a fast, safe and feasible method for detecting vascular injuries of the craniocervical region. It allows prompt further treatment to reduce the risk of cerebral infarction. The CTA is strongly indicated as well in case of cervical spine trauma as trauma mechanisms involving the cervical spine.