Hopper Wade, Spagnolia Alessandra A, Drofa Alexander, Terrell Andrew M
Department of Surgery, University of North Dakota, Grand Forks, ND, USA.
Department of Neurosurgery, Sanford Medical Center Fargo, Fargo, ND, USA.
Am J Case Rep. 2025 Jan 6;26:e945684. doi: 10.12659/AJCR.945684.
BACKGROUND Carotid artery injury has an incidence of 0.2% in the National Trauma Data Bank. The true incidence of intracranial carotid injury is unknown but can be estimated at less than one in 1000 trauma-related inpatient admissions in America. Operatively managed penetrating carotid trauma has a mortality rate approaching 20%, and the selection of the appropriate operative approach is not straightforward. We present a case of penetrating carotid trauma successfully managed via combined approach by neurosurgery and otolaryngology teams. CASE REPORT A 74-year-old woman fell into a honeysuckle bush. She presented with a branch embedded in the left cheek and blindness of the right eye. Further workup revealed the branch had penetrated the maxillary bone, pierced the right optic nerve, and lodged near the intracranial portion of the right internal carotid artery. She underwent emergent operative intervention via right pterional craniotomy with microsurgery and endoscopic transsphenoidal surgery with repair of the skull base. The foreign body was removed and the traumatic carotid laceration was repaired. The patient recovered successfully and was discharged on postoperative day 14. CONCLUSIONS The management of facially penetrating foreign bodies begins with assessment for neurologic deficits and vascular injury. We recommend leaving such objects in place and not removing them until definitive imaging is obtained. We present an interesting case of penetrating trauma to the intracranial carotid artery in which a retained foreign body was removed with satisfactory patient outcome using a combined endoscopic and open surgical approach.
在美国国家创伤数据库中，颈动脉损伤的发生率为0.2%。颅内颈动脉损伤的真实发生率尚不清楚，但据估计在美国每1000例与创伤相关的住院患者中不到1例。手术治疗的穿透性颈动脉创伤死亡率接近20%，选择合适的手术入路并非易事。我们报告一例穿透性颈动脉创伤患者，通过神经外科和耳鼻喉科团队联合手术成功治疗。病例报告：一名74岁女性跌入金银花丛中。她就诊时左脸颊嵌入一根树枝，右眼失明。进一步检查发现树枝穿透上颌骨，刺破右侧视神经，并停留在右侧颈内动脉颅内段附近。她接受了急诊手术干预，通过右翼点开颅显微手术和内镜经蝶窦手术修复颅底。取出异物并修复外伤性颈动脉撕裂。患者成功康复，术后第14天出院。结论：面部穿透性异物的处理首先要评估神经功能缺损和血管损伤。我们建议保留此类异物，在获得确定性影像学检查之前不要取出。我们报告了一例有趣的颅内颈动脉穿透伤病例，采用内镜和开放手术联合方法取出残留异物，患者预后良好。
