Right internal carotid artery C7 segment aneurysm with carotid occlusion following traumatic brain injury: illustrative case

BACKGROUND: Intracranial aneurysms caused by trauma are rare, and occlusion of the carotid vessels caused by trauma is also uncommon. The authors report on the case of a patient who had an internal carotid artery (ICA) aneurysm accompanied by occlusion because of a car accident. OBSERVATIONS: A 37-year-old man presented after a motor vehicle accident with severe traumatic brain injury (TBI), subarachnoid hemorrhage, intraventricular hemorrhage, multiple skull fractures, and right ICA occlusion. Initial CT angiography and digital subtraction angiography showed no aneurysm, and emergency external ventricular drainage was performed. One month later, repeat angiography demonstrated a right C7 ICA aneurysm. CT perfusion showed mild hypoperfusion in the right hemisphere. The patient underwent craniotomy with aneurysm trapping and superficial temporal artery-middle cerebral artery bypass. He later required ventriculoperitoneal shunt insertion for hydrocephalus. Follow-up imaging showed improved perfusion, but marked neurological deficits remained at discharge. LESSONS: In selected patients with traumatic aneurysm and carotid occlusion, microsurgical trapping combined with extracranial-intracranial bypass can be a practical treatment option when endovascular therapy is not suitable. In high-risk TBI, repeat vascular imaging is important even when initial studies are negative. https://thejns.org/doi/10.3171/CASE26241.