Semin intervent Radiol 2021; 38(01): 045-052
DOI: 10.1055/s-0041-1724012
Review Article

Craniofacial Trauma and Vascular Injury

Megan M. Bernath
1   Medical Scientist Training Program, Indiana University School of Medicine, Indianapolis, Indiana
,
Sunu Mathew
2   Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
,
Jerry Kovoor
3   Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations

Abstract

Cerebrovascular injury is a potentially devastating outcome following craniofacial trauma. Interventional radiologists play an important role in detecting, grading, and treating the different types of vascular injury. Computed tomography angiography plays a significant role in the detection of these injuries. Carotid-cavernous fistulas, extra-axial hematomas, pseudoaneurysms, and arterial lacerations are rare vessel injuries resulting from craniofacial trauma. If left untreated, these injuries can lead to vessel rupture and hemorrhage into surrounding areas. Acute management of these vessel injuries includes early identification with angiography and treatment with endovascular embolization. Endovascular therapy resolves vessel abnormalities and reduces the risk of vessel rupture and associated complications.



Publication History

Article published online:
15 April 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Gean A, Le T, Mutch C. Craniofacial trauma. In: Klein S, Brant W, Helms C, Vinson E. eds. Brant and Helms' Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins; 2019: 49-76
  • 2 Inaba K, Munera F, McKenney M. et al. Prospective evaluation of screening multislice helical computed tomographic angiography in the initial evaluation of penetrating neck injuries. J Trauma 2006; 61 (01) 144-149
  • 3 Munera F, Danton G, Rivas LA, Henry RP, Ferrari MG. Multidetector row computed tomography in the management of penetrating neck injuries. Semin Ultrasound CT MR 2009; 30 (03) 195-204
  • 4 Lee TS, Ducic Y, Gordin E, Stroman D. Management of carotid artery trauma. Craniomaxillofac Trauma Reconstr 2014; 7 (03) 175-189
  • 5 Margallo L, Zárate EO, Franco M. et al. Lingual artery pseudoaneurysm after severe facial trauma. Craniomaxillofac Trauma Reconstr 2018; 11 (03) 219-223
  • 6 Cooke D, Ghodke B, Natarajan SK, Hallam D. Embolization in the head and neck. Semin Intervent Radiol 2008; 25 (03) 293-309
  • 7 Yoon N, Shah A, Couldwell WT, Kalani MYS, Park MS. Preoperative embolization of skull base meningiomas: current indications, techniques, and pearls for complication avoidance. Neurosurg Focus 2018; 44 (04) E5
  • 8 Cohen JE, Gomori JM, Segal R. et al. Results of endovascular treatment of traumatic intracranial aneurysms. Neurosurgery 2008; 63 (03) 476-485 , discussion 485–486
  • 9 Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985; 62 (02) 248-256
  • 10 Samii M, Tatagiba M. Skull base trauma: diagnosis and management. Neurol Res 2002; 24 (02) 147-156
  • 11 Jacobson BE, Nesbit GM, Ahuja A, Barnwell SL. Traumatic indirect carotid-cavernous fistula: report of two cases. Neurosurgery 1996; 39 (06) 1235-1237 , discussion 1237–1238
  • 12 Ellis JA, Goldstein H, Connolly Jr ES, Meyers PM. Carotid-cavernous fistulas. Neurosurg Focus 2012; 32 (05) E9
  • 13 Kasturi N, Kumari P, Nagarajan G, Krishnan N. Post-traumatic carotid-cavernous fistula with bilateral proptosis simulating cavernous sinus thrombosis. BMJ Case Rep 2019; 12 (03) e227757
  • 14 Morton RP, Tariq F, Levitt MR. et al. Radiographic and clinical outcomes in cavernous carotid fistula with special focus on alternative transvenous access techniques. J Clin Neurosci 2015; 22 (05) 859-864
  • 15 Luo CB, Teng MM, Chang FC, Chang CY. Traumatic indirect carotid cavernous fistulas: angioarchitectures and results of transarterial embolization by liquid adhesives in 11 patients. Surg Neurol 2009; 71 (02) 216-222
  • 16 Henderson AD, Miller NR. Carotid-cavernous fistula: current concepts in aetiology, investigation, and management. Eye (Lond) 2018; 32 (02) 164-172
  • 17 Chi CT, Nguyen D, Duc VT, Chau HH, Son VT. Direct traumatic carotid cavernous fistula: angiographic classification and treatment strategies. Study of 172 cases. Interv Neuroradiol 2014; 20 (04) 461-475
  • 18 Samaniego EA, Martínez-Galdámez M, Abdo G. Treatment of direct carotid-cavernous fistulas with a double lumen balloon. J Neurointerv Surg 2016; 8 (05) 531-535
  • 19 Baranoski JF, Ducruet AF, Przbylowski CJ. et al. Flow diverters as a scaffold for treating direct carotid cavernous fistulas. J Neurointerv Surg 2019; 11 (11) 1129-1134
  • 20 Ogilvy CS, Motiei-Langroudi R, Ghorbani M, Griessenauer CJ, Alturki AY, Thomas AJ. Flow diverters as useful adjunct to traditional endovascular techniques in treatment of direct carotid-cavernous fistulas. World Neurosurg 2017; 105: 812-817
  • 21 Alexander MD, Halbach VV, Hallam DK. et al. Long-term outcomes of endovascular treatment of indirect carotid cavernous fistulae: superior efficacy, safety, and durability of transvenous coiling over other techniques. Neurosurgery 2019; 85 (01) E94-E100
  • 22 Acerbi F, Farago G, Broggi M. et al. Indocyanine green videoangiographic-guided cannulation of the superior ophthalmic vein for endovascular treatment of carotid-cavernous fistulas. Turk Neurosurg 2017; 27 (05) 832-836
  • 23 Baldauf J, Spuler A, Hoch HH, Molsen HP, Kiwit JC, Synowitz M. Embolization of indirect carotid-cavernous sinus fistulas using the superior ophthalmic vein approach. Acta Neurol Scand 2004; 110 (03) 200-204
  • 24 Dashti SR, Fiorella D, Spetzler RF, Albuquerque FC, McDougall CG. Transorbital endovascular embolization of dural carotid-cavernous fistula: access to cavernous sinus through direct puncture: case examples and technical report. Neurosurgery 2011; 68 (1, Suppl Operative): 75-83, discussion 83
  • 25 El-Hindy N, Kalantzis G, Patankar T. et al. Difficult indirect carotid-cavernous fistulas--alternative techniques to gaining access for treatment. Clin Interv Aging 2014; 9: 1687-1690
  • 26 Haider AS, Garg P, Leonard D. et al. Superior ophthalmic vein access for embolization of an indirect carotid cavernous fistula. Cureus 2017; 9 (09) e1639
  • 27 Lee JW, Kim DJ, Jung JY. et al. Embolisation of indirect carotid-cavernous sinus dural arterio-venous fistulae using the direct superior ophthalmic vein approach. Acta Neurochir (Wien) 2008; 150 (06) 557-561
  • 28 Shah A, Patel BC. Superior Ophthalmic Vein Cannulation for Carotid Cavernous Fistula. Treasure Island, FL: StatPearls Publishing; 2020
  • 29 Wolfe SQ, Cumberbatch NM, Aziz-Sultan MA, Tummala R, Morcos JJ. Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access. Neurosurgery 2010; 66 (6, Suppl Operative): 293-299, discussion 299
  • 30 Prstojević B, Mićović M, Vukasinović I, Nagulić M. Transvenous embolization of dural carotid cavernous fistula through the facial and ophthalmic vein. Vojnosanit Pregl 2011; 68 (12) 1079-1083
  • 31 Bhatia KD, Wang L, Parkinson RJ, Wenderoth JD. Successful treatment of six cases of indirect carotid-cavernous fistula with ethylene vinyl alcohol copolymer (Onyx) transvenous embolization. J Neuroophthalmol 2009; 29 (01) 3-8
  • 32 Elhammady MS, Wolfe SQ, Farhat H, Moftakhar R, Aziz-Sultan MA. Onyx embolization of carotid-cavernous fistulas. J Neurosurg 2010; 112 (03) 589-594
  • 33 Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol 2009; 29 (01) 62-71
  • 34 He HW, Jiang CH, Wu ZX, Li YX, Lü XL, Wang ZC. Transvenous embolization with a combination of detachable coils and Onyx for a complicated cavernous dural arteriovenous fistula. Chin Med J (Engl) 2008; 121 (17) 1651-1655
  • 35 Tjoumakaris SI, Jabbour PM, Rosenwasser RH. Neuroendovascular management of carotid cavernous fistulae. Neurosurg Clin N Am 2009; 20 (04) 447-452
  • 36 Salazar Flores J, Vaquero J, Garcia Sola R. et al. Traumatic false aneurysms of the middle meningeal artery. Neurosurgery 1986; 18 (02) 200-203
  • 37 Bruneau M, Gustin T, Zekhnini K, Gilliard C. Traumatic false aneurysm of the middle meningeal artery causing an intracerebral hemorrhage: case report and literature review. Surg Neurol 2002; 57 (03) 174-178 , discussion 178
  • 38 Marvin E, Laws LH, Coppens JR. Ruptured pseudoaneurysm of the middle meningeal artery presenting with a temporal lobe hematoma and a contralateral subdural hematoma. Surg Neurol Int 2016; 7 (Suppl. 02) S23-S27
  • 39 Peres CMA, Caldas JGMP, Puglia P. et al. Endovascular management of acute epidural hematomas: clinical experience with 80 cases. J Neurosurg 2018; 128 (04) 1044-1050
  • 40 Suzuki S, Endo M, Kurata A. et al. Efficacy of endovascular surgery for the treatment of acute epidural hematomas. AJNR Am J Neuroradiol 2004; 25 (07) 1177-1180
  • 41 Zussman BM, Goldschmidt E, Faraji AH, Salvetti DJ, Jankowitz BT. Middle meningeal artery embolization for the treatment of an expanding epidural hematoma. World Neurosurg 2019; 128: 284-286
  • 42 Ban SP, Hwang G, Byoun HS. et al. Middle meningeal artery embolization for chronic subdural hematoma. Radiology 2018; 286 (03) 992-999
  • 43 Okuma Y, Hirotsune N, Sato Y, Tanabe T, Muraoka K, Nishino S. Midterm follow-up of patients with middle meningeal artery embolization in intractable chronic subdural hematoma. World Neurosurg 2019; 126: e671-e678
  • 44 Tempaku A, Yamauchi S, Ikeda H. et al. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: five cases and a review of the literature. Interv Neuroradiol 2015; 21 (03) 366-371
  • 45 Zheng Y, Lu Z, Shen J, Xu F. Intracranial pseudoaneurysms: evaluation and management. Front Neurol 2020; 11: 582
  • 46 Ribeiro-Ribeiro AL, de Melo Alves Junior S, de Jesus Viana Pinheiro J. Traumatic pseudoaneurysm of the facial artery: late complication and effects on local blood flow. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112 (01) e4-e9
  • 47 Cox MW, Whittaker DR, Martinez C, Fox CJ, Feuerstein IM, Gillespie DL. Traumatic pseudoaneurysms of the head and neck: early endovascular intervention. J Vasc Surg 2007; 46 (06) 1227-1233
  • 48 Shetty NK, Shandilya R, Pawar S, Gadre PK, Gadre K, Singh D. Management of late post-traumatic facial artery pseudoaneurysmal cyst: review of literature. J Maxillofac Oral Surg 2015; 14 (02) 201-205
  • 49 Evans CC, Larson MJ, Eichhorn PJ, Taylor RS. Traumatic pseudoaneurysm of the superficial temporal artery: two cases and review of the literature. J Am Acad Dermatol 2003; 49 (5, Suppl): S286-S288
  • 50 Wang X, Chen JX, You C, He M. Surgical management of traumatic intracranial pseudoaneurysms: a report of 12 cases. Neurol India 2008; 56 (01) 47-51
  • 51 Bresner M, Brekke J, Dubit J, Finizio T. False aneurysms of the facial region. J Oral Surg 1972; 30 (04) 307-313
  • 52 Manuel S, Simon D, George EK, Naik RB. Traumatic pseudoaneurysm of the superficial temporal artery. Clin Pract 2012; 2 (02) e34
  • 53 Stewart CL, Cohen-Kerem R, Ngan BY, Forte V. Post-traumatic facial artery aneurysm in a child. Int J Pediatr Otorhinolaryngol 2004; 68 (12) 1539-1543
  • 54 Hosseini M, Miri S. Traumatic pseudoaneurysm of the superficial temporal artery: a case report. Turk Neurosurg 2013; 23 (04) 531-533
  • 55 Isaacson G, Kochan PS, Kochan JP. Pseudoaneurysms of the superficial temporal artery: treatment options. Laryngoscope 2004; 114 (06) 1000-1004
  • 56 Zhu XL, Ni CF, Liu YZ, Jin YH, Zou JW, Chen L. Treatment strategies and indications for interventional management of pseudoaneurysms. Chin Med J (Engl) 2011; 124 (12) 1784-1789
  • 57 Mann GS, Heran MK. Percutaneous thrombin embolization of a post-traumatic superficial temporal artery pseudoaneurysm. Pediatr Radiol 2007; 37 (06) 578-580
  • 58 Hong JT, Lee SW, Ihn YK. et al. Traumatic pseudoaneurysm of the superficial temporal artery treated by endovascular coil embolization. Surg Neurol 2006; 66 (01) 86-88
  • 59 Ribeiro Ribeiro AL, Brasil da Silva W, Alves-Junior SdeM, de Jesus Viana Pinheiro J. Giant life-threatening external carotid artery pseudoaneurysm caused by a mandibular condylar fracture. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119 (03) e95-e100
  • 60 Ali ZA, Malis DD, Wilson JW. Pseudoaneurysm of the maxillary artery after a stab wound treated by endovascular embolization. J Oral Maxillofac Surg 2007; 65 (04) 790-794
  • 61 Krishnan DG, Marashi A, Malik A. Pseudoaneurysm of internal maxillary artery secondary to gunshot wound managed by endovascular technique. J Oral Maxillofac Surg 2004; 62 (04) 500-502
  • 62 Bignardi E, Pinto F, Pinto A, Niola R, Maglione F. Pseudoaneurism of the left internal maxillary artery following mandibular condyle fracture: diagnosis by color Doppler ultrasonography. A case report. Radiol Med (Torino) 2002; 104 (03) 232-235
  • 63 Chakrabarty S, Majumdar SK, Ghatak A, Bansal A. Management of pseudoaneurysm of internal maxillary artery resulting from trauma. J Maxillofac Oral Surg 2015; 14 (Suppl. 01) 203-208
  • 64 Sumita K, Karakama J, Makita I. et al. [A case of pseudoaneurysm of the lingual artery that was difficult to be distinguished from epistaxis]. No Shinkei Geka 2018; 46 (10) 911-916
  • 65 Matsumoto T, Yamagami T, Kato T, Hirota T, Yoshimatsu R, Nishimura T. Transcatheter arterial embolisation of a ruptured pseudoaneurysm of the lingual artery with n-butyl cyanoacrylate. Br J Radiol 2007; 80 (950) e54-e57
  • 66 Handa KK, Shunyu NB. Post traumatic psuedoaneurysm of the lingual artery. Indian J Otolaryngol Head Neck Surg 2008; 60 (04) 356-359
  • 67 Masella PC, Hanson MM, Hall BT, Verghese JJ, Kellicut DC. Posttraumatic lingual artery pseudoaneurysm treated with ultrasound-guided percutaneous thrombin injection. Ann Vasc Surg 2014; 28 (05) 1317.e11-1317.e15
  • 68 Umana GE, Cristaudo C, Scalia G. et al. Chronic epidural hematoma caused by traumatic intracranial pseudoaneurysm of the middle meningeal artery: review of the literature with a focus on this unique entity. World Neurosurg 2020; 136: 198-204
  • 69 Gerosa A, Fanti A, Del Sette B. et al. Posttraumatic middle meningeal artery pseudoaneurysm: case report and review of the literature. World Neurosurg 2019; 128: 225-229
  • 70 Schuenke M, Schulte E, Schumacher U. Thieme Atlas of Anatomy: Head and Neuroanatomy: Thieme. 2007
  • 71 Tachmes L, Woloszyn T, Marini C. et al. Parotid gland and facial nerve trauma: a retrospective review. J Trauma 1990; 30 (11) 1395-1398
  • 72 McConnell DB, Trunkey DD. Management of penetrating trauma to the neck. Adv Surg 1994; 27: 97-127
  • 73 Thal ER, Meyer DM. Penetrating neck trauma. Curr Probl Surg 1992; 29 (01) 1-56
  • 74 Singh RK, Bhandary S, Karki P. Managing a wooden foreign body in the neck. J Emerg Trauma Shock 2009; 2 (03) 191-195
  • 75 Mahmoodie M, Sanei B, Moazeni-Bistgani M, Namgar M. Penetrating neck trauma: review of 192 cases. Arch Trauma Res 2012; 1 (01) 14-18
  • 76 Shane Hester T, Sylvester S, Kerwin A. et al. Traumatic external carotid artery avulsion not evident on CT angiogram. Am Surg 2017; 83 (08) e277-e279
  • 77 Moar JJ. Traumatic rupture of the cervical carotid arteries: an autopsy and histopathological study of 200 cases. Forensic Sci Int 1987; 34 (04) 227-244
  • 78 Ashraf T, Khan N, Yousaf KM, Yaqub MZ. Endovascular treatment of carotid-internal jugular venous fistula in a bomb blast victim. J Coll Physicians Surg Pak 2017; 27 (02) 110-111
  • 79 Sharma VK, Pereira AW, Ong BK, Rathakrishnan R, Chan BP, Teoh HL. Images in cardiovascular medicine. External carotid artery-internal jugular vein fistula: a complication of internal jugular cannulation. Circulation 2006; 113 (16) e722-e723
  • 80 Dell'Amore A, Castriota F, Calvi S, Magnano D, Noera G, Lamarra M. Post-traumatic carotid-jugular arterio-venous fistula. Heart Lung Circ 2009; 18 (04) 293
  • 81 Wang D, Su L, Han Y, Fan X. Embolization treatment of pseudoaneurysms originating from the external carotid artery. J Vasc Surg 2015; 61 (04) 920-926
  • 82 Langel C, Lovric D, Zabret U. et al. Transarterial embolization of the external carotid artery in the treatment of life-threatening haemorrhage following blunt maxillofacial trauma. Radiol Oncol 2020; 54 (03) 253-262
  • 83 Buchanan RT, Holtmann B. Severe epistaxis in facial fractures. Plast Reconstr Surg 1983; 71 (06) 768-771
  • 84 Bynoe RP, Kerwin AJ, Parker III HH. et al. Maxillofacial injuries and life-threatening hemorrhage: treatment with transcatheter arterial embolization. J Trauma 2003; 55 (01) 74-79
  • 85 Liu WH, Chen YH, Hsieh CT, Lin EY, Chung TT, Ju DT. Transarterial embolization in the management of life-threatening hemorrhage after maxillofacial trauma: a case report and review of literature. Am J Emerg Med 2008; 26 (04) 516.e3-516.e5
  • 86 Thaller SR, Beal SL. Maxillofacial trauma: a potentially fatal injury. Ann Plast Surg 1991; 27 (03) 281-283