Management Approach of Penetrating Vertebral Artery Injury with Concomitant Cervical Nerve Root Injury in Regional Hospital: Report of Two Cases

Abstract

Penetrating vertebral artery injury is uncommon yet potentially fatal. We present two cases of penetrating vertebral artery injury with concomitant cervical nerve root injury managed in our centre. The first case was a young gentleman who suffered from neck injury by broken metal fragment. Cervical nerve root injury was suspected preoperatively. Massive bleeding from vertebral artery was encountered during wound exploration. It was managed by ligation, followed by retrograde endovascular embolisation. The second case was a young lady being assaulted with knife and fork over the neck. She was also suspected to have cervical nerve root injury preoperatively. Vascular control of vertebral artery was achieved with endovascular intervention. Subsequent operation for foreign body removal and nerve root repair was performed with minimal bleeding intraoperatively. Management approach of penetrating vertebral artery injury with concomitant cervical nerve root injury and the role of endovascular intervention were discussed.