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.
