Traumatic Vertebral Artery Stenosis Inflicted by Stray Arrow

Area of Science:

• Trauma Surgery
• Vascular Surgery
• Neurosurgery

Background:

• Penetrating neck trauma presents unique challenges, especially when vital structures like the vertebral artery are at risk.
• Accurate anatomical localization and pre-operative planning are crucial for managing complex neck injuries.

Purpose of the Study:

• To describe the successful management of a rare case of penetrating neck trauma with an arrow lodged near the cervical spine and vertebral artery.
• To highlight the importance of multidisciplinary collaboration and advanced imaging in achieving optimal outcomes.

Main Methods:

• A 17-year-old female with an arrow in her neck underwent Computed Tomography (CT) and Digital Subtraction Angiography (DSA) for precise localization.
• A hybrid operating suite facilitated emergency surgery involving balloon occlusion of the right vertebral artery prior to arrowhead extraction and subsequent hemostasis.

Main Results:

• The arrowhead was lodged near the transverse foramen of the third cervical vertebra, approximately 2 mm from the right vertebral artery.
• Successful extraction was achieved with temporary balloon occlusion of the vertebral artery to control bleeding, followed by hemostasis.
• Post-extraction angiography showed focal narrowing of the vertebral artery without contrast extravasation, and the patient had no neurological deficits.

Conclusions:

• This case demonstrates the successful management of a high-risk penetrating neck injury involving the vertebral artery through meticulous pre-surgical planning and a collaborative surgical approach.
• The use of temporary balloon occlusion and advanced imaging techniques was critical in preserving vascular integrity and preventing neurological complications.