Indirect surgical management of a penetrating vertebral artery injury

Introduction Vertebral artery injury caused by penetrating neck trauma is a rare occurrence. Direct surgical repair is difficult due to anatomy and exposure. Proximal and distal ligation or/and embolization represent the most common management in cases which require intervention. Case report A young man accidentally stabbed in the neck was admitted to the emergency department with active arterial bleeding from the wound. Immediate surgical exploration revealed an isolated injury of the left vertebral artery intraosseous segment. Lesion was managed by proximal segment ligature and distal Fogarty catheter balloon-tamponade. Postoperative angiography excluded the need for further interventions. Balloon-catheter was successfully extracted after 72 hours and patient discharged neurologically intact on postoperative day 7. Fourteen months later, there are no signs of vascular or neurologic complications. Conclusion Balloon-tamponade is a valuable technical adjunct in either temporizing or definitive management of surgically inaccessible vascular trauma.

Download Full-text

Emergency Endovascular Treatment of a Penetrating Vertebral Artery Injury with Detachable Coils

Rivista di Neuroradiologia ◽

10.1177/197140090501800119 ◽

2005 ◽

Vol 18 (1) ◽

pp. 117-121

Author(s):

H. Akan ◽

K. Atalay ◽

Ü. Belet ◽

Z. Özmen ◽

S. Gelmez

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Surgical Approach ◽

Stab Wound ◽

Active Bleeding ◽

Vertebral Artery Injury ◽

Left Vertebral Artery ◽

Artery Injury ◽

Bony Canal ◽

Detachable Coils

The surgical approach is difficult and time-consuming in cases of injury to the bony canal segment of the vertebral artery. Diagnosis and treatment should be performed urgently if the patient has active bleeding. We present a patient with a left vertebral artery injury in a stab wound to the neck in whom emergency endovascular treatment was performed with detachable coils because of ongoing gross bleeding.

Download Full-text

Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

Case Reports in Neurological Medicine ◽

10.1155/2015/571656 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Chadi Tannoury ◽

Anthony Degiacomo

Keyword(s):

Cervical Spine ◽

Vertebral Artery ◽

Gunshot Wound ◽

Vertebral Artery Injury ◽

Left Vertebral Artery ◽

Cerebellar Infarction ◽

Cervical Spine Trauma ◽

Spine Trauma ◽

Neurologic Sequela ◽

Artery Injury

Study Design. This case illustrates complications to a vertebral artery injury (VAI) resulting from penetrating cervical spine trauma.Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck.Summary of Background Data.Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur.Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death.Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction.Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

Download Full-text

Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: case report

Romanian Neurosurgery ◽

10.1515/romneu-2016-0014 ◽

2016 ◽

Vol 30 (1) ◽

pp. 92-97

Author(s):

Luis Rafael Moscote-Salazar ◽

Andres M. Rubiano ◽

Willem Guillermo Calderon-Miranda ◽

Amit Agrawal

Keyword(s):

Ct Scan ◽

Vertebral Artery ◽

Causative Factor ◽

Neurological Status ◽

Vertebral Artery Injury ◽

Left Vertebral Artery ◽

Cerebellar Infarction ◽

Artery Injury ◽

Extrinsic Compression ◽

Posttraumatic Cerebral Infarction

AbstractPosttraumatic cerebral infarction is an uncommon cause of morbidity and mortality and many studies have highlighted that trauma needs to considered as causative factor for cerebellar infarction. We present a case of cerebellar infarction in a 35 year old young patient secondary to vertebral fracture involving the vertebral foramen and vertebral artery injury. CT scan cervical spine showed C2-3 fracture on left side with fracture extending into the left vertebral foramen. A CT scan angiogram could not be performed because of poor neurological status. Possibly the infarction was due to left vertebral artery injury. Without surgical intervention prognosis of these patients remain poor. Prognosis of patients with traumatic cerebellar infarction depends on the neurological status of the patient, intrinsic parenchymal damage and more importantly extrinsic compression of the brainstem by the edematous cerebellar hemispheres.

Download Full-text