title: The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report.
abstract: Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
keywords: Digital subtraction angiography; Multidetector computed tomography; Neck injury