Successful Surgical Management of Intracranial Carotid Artery Trauma Following Penetrating Facial Injury: A Case Report

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.