Arteriovenous fistulas resulting from gunshot wounds to the head

One of the key reasons for the high incidence of adverse outcomes in gunshot wounds to the head is the multifactorial damaging effect of high-energy projectiles. One complication of gunshot wounds to the neck or head is traumatic arteriovenous fistulas (AVFs). The cases of traumatic intracranial AVFs resulting from gunshot wounds to the head, involving the proximal segments of the internal carotid artery (ICA) or other major cerebral arteries are unique if they are accompanied by a favorable clinical outcome. Russian and foreign literature sources do not provide information on clinical observations of traumatic intracranial extradural AVFs. The article describes a clinical case of a patient with traumatic intracranial extradural carotid-jugular fistula resulting from a gunshot fragment through-and-through craniobasal wound to the head in the left occipital region, with a comminuted fracture of the occipital bone, a through-and-through fracture of the pyramid of the left temporal bone, a perforated fracture of the left greater wing of the sphenoid bone, an exit wound in the soft palate, and the formation of brain contusion foci along the wound channel. Clinically suspected and confirmed by ultrasound and computed tomographic angiographic studies of the brachiocephalic vessels, a traumatic carotid-jugular fistula was identified within the wound tract at the defect of the left temporal bone, combined with ICA occlusionat the C2 (petrous) segment, which did not lead to ischemic stroke on the affected side. Selective cerebral angiography was performed, followed by embolization of the left ICA stump in the cervical segment using detachable microcoils, achieving disconnection of the AVF. This case of traumatic carotid-jugular fistula is unique and demonstrates the possibility of a favorable outcome gunshot wound to the head due to timely diagnosis and endovascular intervention. The expediency of computed tomographic angiography for all patients with combat trauma to the head and neck is justified.