A Unique Case of Penetrating Neck and Cervical Spine Trauma Resulting in Vertebral Artery Transection and Internal Carotid Artery Dissection

Objective: Penetrating neck trauma is associated with a high risk of morbidity and mortality. This report aims to demonstrate how simultaneous injuries to the internal carotid artery, vertebral artery, and spinal canal can be managed via multidisciplinary endovascular and open surgical approaches. Study Design: Case report. Methods: The electronic medical record was used for data collection. Results: A 20-year-old male was impaled with a wooden projectile. The object penetrated the face lateral to the maxilla, passing through the parapharyngeal space, where it splits into two fragments resulting in fractures through the transverse foramen and anterior process of C1. Imaging revealed an internal carotid artery dissection, vertebral artery transection, cervical spine subdural hematoma, and the retained foreign body. Interventional angiography allowed for vascular injury assessment and endovascular embolization of the proximal and distal segments of the compromised vertebral artery. This was followed by an anterior cervical surgical exploration with ligation of the internal carotid artery, parapharyngeal space dissection, and subsequent foreign body extraction. This approach safely allowed for control of hemorrhage and cerebral spinal fluid leak following foreign body removal. Conclusion: The combination of endovascular and open approaches for complex level III penetrating neck trauma associated with multivascular injury can minimize morbidity and mortality from these rare injuries.