Neuroendovascular Surgery Applications in Craniocervical Trauma

Purpose— Cerebrovascular injuries after blunt or penetrating trauma to the head and neck often lead to local
hemorrhage and stroke. A large number of manifestations can be seen including carotid or vertebral artery dissection,
pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid cavernous fistula, epistaxis, venous sinus
thrombosis, and subdural hematoma.
Methods— A selective review of the literature reporting various neuroendovascular surgery techniques in
craniocervical trauma was performed. The authors conducted a PubMed search from 1989-2020 including the terms:
endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm,
carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and
middle meningeal artery embolization.
Results— An increasing number of neuroendovascular procedures are currently available to treat these traumatic
injuries. Lesions can be embolized using coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl al
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cohol particles. Stent placement using uncovered, covered, and overlapping stents; mechanical thrombectomy using
stent-retrievers or aspiration catheters; and balloon occlusion tests and supraselective angiography to assess the safety
of therapeutic arterial occlusion are additional options depending upon the underlying lesion.
Conclusion— Neuroendovascular techniques can often treat conditions where surgical options are otherwise
limited. However, there is limited data comparing neuroendovascular and surgical techniques in the setting of trauma.