Craniofacial Trauma and Vascular Injury

Abstract

Cerebrovascular injury is a potentially devastating outcome following craniofacial trauma. Interventional radiologists play an important role in detecting, grading, and treating the different types of vascular injury. Computed tomography angiography plays a significant role in the detection of these injuries. Carotid-cavernous fistulas, extra-axial hematomas, pseudoaneurysms, and arterial lacerations are rare vessel injuries resulting from craniofacial trauma. If left untreated, these injuries can lead to vessel rupture and hemorrhage into surrounding areas. Acute management of these vessel injuries includes early identification with angiography and treatment with endovascular embolization. Endovascular therapy resolves vessel abnormalities and reduces the risk of vessel rupture and associated complications.

Combining Endovascular Coiling and Open Evacuation for a Delayed-Onset Ruptured Post-traumatic Pseudoaneurysm of the Distal Paracentral Pericallosal Artery Branch

“…This case demonstrates that pseudoaneurysm development and rupture can be a delayed complication of trauma. Although initial screening CTA is performed for patients with nonpenetrating trauma meeting the Modified Denver Criteria, the initial CTA in our patient was negative [ 4 , 5 ]. Change in neurological status five days after the initial traumatic incident prompted repeat CTA, which revealed the ruptured pseudoaneurysm.…”

“…Prior literature describes approaching post-traumatic pseudoaneurysms or aneurysms with either an endovascular coil embolization or surgical evacuation with microvascular repair, depending on whether there is rupture or extravasation [3,4,[8][9][10]. Consideration for an approach to treatment includes the ability to endovascularly access the lesion and embolize it with maximal preservation of parental vessels [6].…”

“…There is a high index of suspicion for cerebrovascular injury in cases of penetrating trauma, but it may be missed in patients presenting with blunt head and neck traumatic injuries, which are considered to be low mechanisms [ 1 , 2 ]. Vascular abnormalities, such as intracranial aneurysms, hematomas, carotid-cavernous fistulas, pseudoaneurysms, and vessel lacerations, can develop secondary to both penetrating and blunt head trauma [ 3 , 4 ]. Although computed tomography angiography (CTA) is the imaging modality of choice to detect post-traumatic cerebrovascular abnormalities, it is often not performed in cases of mild trauma [ 4 , 5 ].…”

“…Vascular abnormalities, such as intracranial aneurysms, hematomas, carotid-cavernous fistulas, pseudoaneurysms, and vessel lacerations, can develop secondary to both penetrating and blunt head trauma [ 3 , 4 ]. Although computed tomography angiography (CTA) is the imaging modality of choice to detect post-traumatic cerebrovascular abnormalities, it is often not performed in cases of mild trauma [ 4 , 5 ].…”

“…Post-traumatic aneurysms and pseudoaneurysms may be treated with various endovascular methods to stabilize the compromised vessel and prevent subsequent rupture [4,[6][7][8]. If undetected and untreated, subsequent rupture and hemorrhage can occur, presenting clinically as an acute change in neurological status [1,4,8]. Treatment includes surgical evacuation with microvascular repair [7,9].…”