COMBINED TREATMENT FOR A PATIENT WITH A GUNSHOT CRANIOFACIAL INJURY: A CLINICAL CASE

Background. Cerebral vascular injury (CVI) covers various forms of intra- and extracranial vascular damage to the brain resulting from head and neck trauma or injuries. This condition is considered the most severe complication of craniocerebral injuries and injuries with a high mortality rate. Purpose. To examine through a clinical case, the possibility of using combined endovascular and endoscopic surgical methods for treating a wounded patient with cerebral vascular injury. Materials and methods. A 45-year-old patient was admitted to the Neurosurgical Center of the N.N. Burdenko Main Military Clinical Hospital through in May 2024 via medical evacuation. He had a shrapnel craniofacial blind penetrating wound of the midface with a fracture of the facial bones and a fragment in the posterior wall of the sella turcica. According to selective angiography, the wounded patient had a pinpoint injury to the intracavernous part of the left internal carotid artery (ICA). Results. The patient underwent endovascular trapping occlusion of the cavernous part of the left ICA due to bleeding. Then, endoscopic transnasal removal of a metal fragment from the anterior part of the left cavernous sinus was performed. The measures taken allowed to stabilize the patient's condition for a short time, however, due to the development of ischemic and secondary infectious complications, the patient died on the 33rd day after the injury. Conclusions. Based on the presented clinical case, we would like to focus on the most important aspects of urgent neurosurgical care for injuries accompanied by damage to the cerebral vessels.