Cranial Base Fractures Research Articles

Early Treatment of Cerebrospinal Fluid Leakage After Traumatic Injury Using Pedicled Autologous Fascia Flap.

This study aims to investigate the efficacy of early intervention in cerebrospinal fluid leakage following traumatic brain injury through the utilization of pedicled autologous fascia flaps. A retrospective case series, spanning from May 2021 to May 2022, analyzed 8 traumatic brain injury cases with concomitant cerebrospinal fluid leakage. Each patient underwent simultaneous brain surgery and transcranial repair of the cerebrospinal fluid leak, employing a pedicled autologous fascia flap. Clinical and imaging data were comprehensively recorded throughout the entire duration of the cases, and patient follow-ups were conducted through outpatient visits and telephone consultations. The study comprised 8 enrolled patients, consisting of 7 males and 1 female, all of whom sustained injuries from traffic accidents. The mean age ranged from 17 to 55 years. Among the patients, three presented with acute epidural hematoma, three with simple concave fractures, and 2 with concave fractures accompanied by brain contusion. Frontal sinus fractures were observed in all cases. All surgical interventions were successful, with no instances of cerebrospinal fluid leakage postoperatively. In addition, none of the patients developed intracranial infections. At the conclusion of the follow-up period, recurrent cerebrospinal fluid leakage was not observed in any of the patients. In cases where surgical intervention is necessary for cerebrospinal fluid leakage resulting from anterior cranial base fractures, the application of pedicled autologous fascia flaps in the acute stage proves effective in repairing leaks at the anterior cranial base. This approach may contribute to a reduction in the incidence of intracranial infections, ultimately yielding satisfactory patient recovery.

MENGUNGKAP PERISTIWA KEMATIAN KRIMINAL KASUS PEMBEKAPAN PERSPEKTIF MEDIKOLEGAL

Death is a definite thing in life that can be identified clinically in a person through observing the changes that occur in the corpse's body. The mechanism of death can be unnatural. In this case, wounds were found in the mouth, a form of mechanical smothering. Smothering can cause death, so it is an important reason to discuss and aims to reveal unnatural injuries and what events occurred. The examination method uses the principles of evidence based medicine. On external examination, bruises were found on the inner lips, both eyes (racoon eyes), left cheek, upper jaw, lower jaw, abrasions on the lips with teeth prints, and cheeks and several other bodies injuries. The lips, the tips of both fingers and the tips of the toes were bluish in color and bleeding spots were found on both inner eyelids. The conclusion of the external examination of the corpse showed that the wounds were unnatural and there were signs of strong pressure on the mouth and nose area which could cause suffocation and there were signs of cranial base trauma. These wounds were caused by blunt trauma Key words: Asphyxia, Cranial Base Fracture, smothering

Guillain-Barré Syndrome Mimicking Brainstem Death Following Traumatic Intracerebral Hemorrhage (P12-7.006)

<h3>Objective:</h3> NA <h3>Background:</h3> NA <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 73-year-old man attended the ED following an assault where he sustained multiple traumatic blows to the head. He was alert, complained of headache but provided a detailed account. There were facial injuries but no clinical signs of cranial or skull base fractures. There was injury to the right eye, in which he had pre-existing visual impairment from previous injury. Vision was normal in the left. Right pupillary light reflex was absent but left was normal. The remainder of the neurological examination was unremarkable. CT-Head identified a small traumatic subarachnoid hemorrhage over the left cerebral convexity and a small contusion in the left temporo-parietal region. Vitreous hemorrhage was evident in the right eye. Clinically stable, follow-up CT on day 3 showed small intra-cerebral haemorrhage within the contusion, with minimal mass effect. However, on day 8, his GCS dropped and he was admitted to the ITU for airway management. Both pupils were non-responsive to light. Expansion of haemorrhage was suspected, however repeat CT was stable. EEG showed slowing over the left hemisphere without epileptiform activity. MRI excluded alternative causes for his neurological status such as brainstem ischaemia. With no clinical improvement, formal brainstem death testing was initiated. No potential confounders were recognised. The pupillary, corneal, oculocephalic, cough and gag reflexes were absent. Unexpectedly, deep tendon reflexes were absent in all limbs. A peripheral nerve stimulator using a train-of-four test protocol found no response. Post-traumatic Guillain-Barré syndrome (GBS) was suspected. Intravenous immunoglobulin was commenced. Nerve conduction studies found absent motor and sensory responses in all limbs. EMG showed fibrillation potentials and sharp waves. These findings were consistent with acute motor-sensory axonal neuropathy (AMSAN) variant of GBS. Serum Anti-GM1 antibodies were identified. After multiple rounds of plasmapheresis the patient was weaned from the ventilator. Nevertheless, severe neurological disability remained. <h3>Conclusions:</h3> NA <b>Disclosure:</b> Dr. Finegan has nothing to disclose. Dr. Ryan has nothing to disclose. Michael J. Hennessy has nothing to disclose. Kevin Murphy has nothing to disclose. Dr. Crowley has nothing to disclose. Dr. Elamin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche .

A Comparative Study of Intravital CT and Autopsy Findings in Fatal Traumatic Injuries.

Objectives: Traumatic injuries are one of the severe health problems of our time. In the 21st Century, approximately 4.5 million people worldwide die each year due to trauma. Computed tomography (CT) is widely used to diagnose injuries and offers information on the specific location and extent of organ and tissue damage. In cases of severe trauma, whole-body CT is increasingly used as a standard diagnostic technique. An autopsy is the final diagnostic examination and is still considered the gold standard in diagnostic methods in medicine. The aim of the study was to assess the reliability and accuracy of CT scan results, as well as limits in detecting trauma for forensic purposes. It aims to compare traumatic findings in the antemortem CT results to those observed at autopsy. Materials and Methods: We conducted a retrospective–prospective study involving 510 deaths due to trauma. We compared selected traumatic changes in the antemortem CT scan results with the autopsy findings. We obtained data with a detailed analysis of autopsy protocols, photographic documentation from the autopsies, and the interpretation of CT scans from medical documentation. In cases of discrepancies in the findings, we borrowed CT scans, which were repeatedly reviewed by clinical radiologists. Results: By comparing the findings of selected injuries detected by antemortem CT and autopsy, we found a correlation of findings in 75.3% and a discrepancy of findings in 24.7% in a set of 510 cases. After repeated targeted assessment of CT images by clinical radiologists in cases of discrepancies in the findings, which were detected by autopsy and undescribed by CT, the discrepancy decreased to 17%. Conclusions: The results of the study are comparable with data from many studies and professional publications. They show that CT compared to autopsy is a good method for diagnosing gunshot wounds to the head and bone fractures, with a limited diagnosis of cranial base fractures, while an autopsy is better for detecting minor injuries to organs and soft tissues.

Expanding pneumocephalus due to craniofacial fractures: A case report.

IntroductionPneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is craniofacial trauma, though there are many etiologies, including surgical procedures. PNC with compression of the frontal lobes and widening of the interhemispheric space between the tips of the frontal lobes results in the characteristic radiological finding of the “Mount Fuji sign”.Presentation of caseA 57-year-old man presented to the A&E with loss of consciousness due to a motorcycle collision 9 h prior. He had a GCS of E4M6V5, and a head CT scan revealed minimal PNC forming in both hemispheres. After discharge, severe headaches and rhinorrhea developed. A second CT scan revealed a massive PNC. An operation was then performed via a bicoronal incision to drain the PNC and seal the cranial defect. A burr hole in the calvarium was created, and the cranial defect was closed using a pericranial rotational flap. Post-operation, the patient's headache and rhinorrhea decreased; neither symptom was present at 1-month post-operation. The wounds healed with minimal scarring, and the cosmetic outcome for the craniofacial fracture was acceptable.DiscussionAlthough the patient may at first present with a mild head injury, this can progress into something much more serious. PNC is difficult to diagnose clinically. Rarely, patients describe a splashing sound upon moving the head (termed bruit hydro-aerique), which can also be auscultated. A head CT scan is the gold standard in the diagnosis of PNC. Pericranial flaps are widely used for dural repair because they are easily accessible and have a lower rate of infection than artificial grafts on expanding PNC.ConclusionTension PNC may be slow-growing and increase intracranial pressure to high levels before clinical signs are present. The pericranial rotational flap technique is the best way to close a dura mater defect in cranial base fractures with tension PNC.

The Frequency of Cranial Base Fractures in Lethal Head Trauma.

The interpretation of cranial base injuries has never been investigated from a purely anthropological perspective. Very little exists in forensic literature in order to interpret the significance of cranial base fractures. We analyzed 296 cases of deaths due to skull-brain injuries. The frequency of vault fractures was 75.7% and that of base fractures was 91.9%. We observed the distribution of cases of death according to manner of death and manner of injury and number of fossae involved. These observations were analytically compared to different variables (age, sex, manner of injury, and mode of injury). The study presented the proportion of base fractures associated with vault fractures, and the frequency of absence of base fracture in subjects with no vault fractures. Interesting associations of base fractures to age and manner of death are shown.

The Cranial Base Fracture after the Caldwell-Luc Operation.

Supplemental Digital Content is available in the text.

Spontaneous Recovery of Post-Traumatic Cerebrospinal Fluid Rhinorrhea Following Meningitis : A Case Report

The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention.

Extensive Anterior Cranial Base Fractures: Anatomic and Surgical Description of Combination Flaps

Introduction: Traditionally, cerebrospinal fluid (CSF) fistula repair following anterior skull base fractures has been accomplished with the use of exclusive anterior-based pericranial flaps. Over time, limitations have been identified with this technique. Persistent CSF leak rates following initial repairs are 12.5 to 17%, and could potentially be contributed to compromise blood supply resulting from initial cranial insult. In addition, glabellar tissue defects from placement of these flaps can result in poor cosmesis. The limited posterior reach of these flaps can hinder repairs in fractures with a substantial posterior extent. This has led to the addition of lateral temporoparital fascial flap and nasoseptal flap to our repair techniques.

Presentation of multiple midface fractures combined with intracranial injury treated conservatively

Midface injuries are normally the result of high forces impacted on the face, that can bypass the power of the connection buttresses, which are thick and strong, base of skull is also a rigid and toughstructure which requires significant forces to break. In our case, multiple midface and cranial base fractures are presented, which reflect injury caused by high forces and normally, these result in instability in the facial skeleton, or cause CSF rhinorrhea, or sharp spicules to endanger the orbit or the anterior cranial fossa, or the presence of any other indication of surgery. It is unusual to find such an extent of facial trauma and such a multiplication of fractures on the midface and cranial base levels, yet they were stable enough and without a real indication to require surgical interference.

外傷性頸動脈海綿静脈洞瘻を併発した顎骨骨折の1例

Traumatic carotid-cavernous sinus fistula （tCCF） is an arteriovenous shunt caused by internal carotid artery rupture in the cavernosus sinus, resulting from head injury. This leads to a triad of symptoms including pulsating exophthalmos, chemosis with conjunctival hyperemia, and orbital bruit. Because of life-threatening problems and local swelling after injury, it is difficult to diagnose tCCF at an early stage. Delayed treatment can cause irreversible neurological and/or ophthalmological damage. Moreover, it may lead to profuse nasal bleeding and even death. Here, we report a rare case of tCCF with a facial fracture after a sports accident. A 35-year-old man suffered a facial injury by bumping against another player during a baseball game. He had multiple fractures of the mandible and maxilla, but no other fractures, including cranial base fracture, were apparent. Open reduction and fixation of the mandible and conservative reduction of the maxilla were performed under general anesthesia. Exophthalmos and ophthalmoplegia were noted on the 16th day after injury. Diagnostic imaging was performed, and a neurosurgeon diagnosed tCCF. Successful management was achieved with no sequelae by endovascular surgery. Careful observation and prompt cooperation with specialists are very important for the treatment of maxillofacial trauma.

Mucocele after transnasal endoscopic repair of traumatic anterior skull base fistula in children

Objectives To report the long-term sinonasal complications after endoscopic repair of anterior skull base fractures in children. This study describes mucocele formation in 6 patients treated endoscopically for posttraumatic CSF fistulae. We aim to address possible etiologic factors, specific treatments and follow-up modalities. Patients and methods 12 children, mean age 5.8 years (3–10), treated endoscopically at our institution between 2004 and 2010 for an anterior cranial base fracture complicated by a CSF fistula. An iatrogenic mucocele was observed in 6 cases. A retrospective review of the files of these 6 patients was carried out demonstrating demographic characteristics, presenting signs/symptoms, site of skull base defect, repair technique, timing and onset of the mucoceles, their presentation and management. A systematic CT-scan and/or MRI was carried out at 3 months, 1 year and then annually. Results 3 patients presented after cranial trauma with persistent CSF nasal leak, and 4 with meningitis. Posttraumatic defects reached the posterior wall of the frontal sinus and the junction of ethmoid and frontal bone in 3 cases, and the cribriform plate in 3 cases. Endoscopic closure was performed in all cases, with the middle turbinate as an overlay patch. No recurrence of a CSF leak was observed. After a mean period of 16 months, a single iatrogenic mucocele was observed in 4 patients (radiological detection only), and multiple mucoceles in 2 patients. Surgical treatment was advocated in cases of proptosis, quick expansion of the mucocele leading to sinus bony wall remodelling or erosion (2 cases), and meningitis related to an erosion of the cribriform plate by the mucocele. Three mucoceles were successfully treated endoscopically, and 1 required an external approach. Conclusion Mucocele incidence after endoscopic repair of skull base fractures in children is not insignificant (50% in our 12 patients series). Paediatric anatomical features, cranial trauma, and the transethmoidal approach may play a role in mucocele pathogenesis. Long-term clinical and radiological follow-up is therefore recommended. These mucoceles may be managed endoscopically with good outcomes.

Pediatric Craniofacial Trauma: Challenging Pediatric Cases—Craniofacial Trauma

The pediatric population, as well as the adult population, is subject to similar injuries and traumatic events involving the craniofacial skeleton. Although less frequent than adult injuries, the craniofacial injuries sustained by children are considered separately in textbooks and the literature because of the special unique problems associated with their treatment and the effects they might have on growth and development that can arise as a result of their management. Some of the more challenging cases that I have seen involve the very young with cranial bone fractures and cranial base fractures and those that involve the nasal and/or orbital-ethmoidal areas in young children and their secondary reconstruction. Some of these types of cases are not always clearly and thoroughly addressed in textbooks or articles because of their infrequent occurrence. Often, surgeons differ in approaches to treatment because of certain anatomic or physiological factors specifically related to childhood, facial growth, and the timing of treatment. Some of the cranial and facial developmental malformations seen in older children or adults can be attributed to trauma sustained in early childhood. This is because trauma may have a deleterious effect on the growth and development of facial structures in the postnatal life similar to that seen resulting from a genetic mutation.

Case report: Forensic anthropological assessment in a suspected case of child abuse from South Africa

Not many case reports of suspected child abuse as assessed solely on skeletal remains are available. Forensic anthropologists have intimate knowledge of normal skeletal anatomy, bone trauma and processes of healing of bone and may therefore be of help in suspected cases of child abuse. Patterns of trauma in juvenile skeletal remains which are suggestive of abuse include fractures in different phases of healing, multiple fractures, typical fractures on ribs and long bones and severe, complicated cranial fractures. The aim of this paper is to report on the findings of the analysis of the skeletal remains of a 3.5 years old boy. Forensic pathological examination indicated that the boy had died from a massive cranial fracture, with multiple injuries present to the rest of the body. After the body had been buried for some time, it was exhumed and we were requested to look for signs of chronic, long-term abuse. Findings included a massive cranial fracture, another fracture in the roof of the orbit, two areas of non-specific subperiosteal bone growth and several untreated carious teeth. No clear healed fracture could be found, except for a possible healed cranial base fracture which stretched transversely across the petrosal bone. This area showed signs of recent bone activity. The court decided that this was not enough evidence of chronic abuse and found the accused guilty of murder but not of chronic child abuse. This case illustrates the difficulty to obtain clear signs of chronic injury on juvenile remains.

Transorbital Neuroendoscopic Surgery

Transorbital neuroendoscopic surgery (TONES) pathways attempt to address some of the technical challenges of accessing laterally placed anterior skull base lesions or paramedian lesions that cross neurovascular structures. TONES approaches allow simultaneous coplanar visualization and working space above and below the skull base. To present an anatomic study, a description of the surgical techniques, and an analysis of the safety and efficacy of 20 consecutive procedures using TONES for a variety of pathological conditions. Sixteen patients underwent 20 TONES procedures for anterior skull base pathology, including repair of cerebrospinal leak, optic nerve decompression, repair of cranial base fractures, and removal of 3 skull base tumors. Ten patients were male, and 6 were female. The mean age at presentation was 44 years. Follow-up was 6 to 18 months with a mean of 9 months. There were no significant complications or treatment failures in any of the 20 procedures. A variety of pathological conditions were treated, including cerebrospinal fluid leaks, fractures, mass lesions, and tumors. The TONES approach provided up to 4 separate access ports with ample exposure for manipulation and correction of the pathology. This anatomic and prospective outcome study demonstrates that TONES provides safe and effective coplanar endoscopic access to the anterior and middle cranial base. These novel TONES approaches may be added to the wide range of published minimally invasive armamentarium when approaching challenging skull base pathology.

Surgical Strategy for Cerebrospinal Fluid Rhinorrhea Repair

Cerebrospinal fluid (CSF) rhinorrhea is leakage of CSF from the nasal cavity caused by cranial base or meningeal defects. Surgical treatment of CSF rhinorrhea is still problematic. We evaluated the clinical outcomes of 132 consecutive cases of CSF rhinorrhea treated via transcranial or transnasal endoscopic approaches according to the patient's condition. The indications for the approaches are discussed. Of 132 patients with CSF rhinorrhea, a transnasal endoscopic approach was used in 98 to repair cranial base defects in the ethmoid and sphenoid sinuses. A transcranial intradural approach was used in the remaining 34 patients for frontal sinus defects, multiple fractures of the cranial base, or combination nerve injury. CSF rhinorrhea resolved after initial surgery in 124 of 132 patients, giving a success rate of 94%. Of the 8 failures or recurrent cases, 4 were successfully repaired by repeat endoscopic surgery, 2 were cured by transcranial revision surgery, and 2 refused additional surgery (the condition subsequently resolved without treatment in these patients). Postoperative complications included intracranial infection (8 patients) and anosmia (1 patient). No neurological deficits were apparent over the 10-month mean follow-up period. Transnasal endoscopic repair is a reliable method for CSF rhinorrhea patients whose fistulae are located in the ethmoid and sphenoid sinuses. The transcranial procedure should be the treatment of choice for patients with frontal sinus fracture, multiple or complex anterior cranial base fractures, or nerve injury. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon's skill and experience.

Refrigeration-induced skull base fracture: three autopsy cases

Three cases of death are described where all the refrigerated skull of corpses showed cranial base fracture. A question arose whether these fractures were caused by head injury. As the details were clear and both autopsy and relative pathological findings displayed nothing positive, it was presumed that the cranial base fracture was due to the expansion of brain volume and increased intracranial pressure after refrigeration. And the evidence showed that the suspicious fracture was to be classified as an uncommon refrigeration-induced post-mortem artefact.

Frontobasal Fractures: Anatomical Classification and Clinical Significance

Frontobasal injury is a classic craniomaxillofacial fracture affecting the anterior cranial base. No data exist regarding the degree of frontobasal injury and associated midfacial fractures. The authors propose a classification of frontobasal and midface fractures involving the cranial base based on cadaveric experiments and comprehensive clinical experience. An institutional review board-approved retrospective review was conducted on patients with frontobasal fractures from 1995 to 2005. Fractures were categorized by pattern, location, midfacial involvement (impure), and complications compiled. One hundred five cadaveric heads underwent blunt impact to the frontal bone and upper midface. Calvarial vault, cranial base, and midface fracture patterns were categorized. Three frontobasal fracture patterns were identified. Isolated linear cranial base fractures constitute type I. Vertical-linear fractures of the skull vault (frontal bone) occur in combination with base fractures, representing type II (vault and base). Comminution of the frontolateral skull vault and orbital roof in association with a linear base fracture constitute type III. Two hundred ninety patients were identified with 49 complications (cerebrospinal fistula, 24; and infectious 25). Type III (n = 159) had the highest complication rate (impure, 29 percent; pure, 17 percent), followed by type II (impure, 19 percent; pure, 5 percent). There is essentially no extension of midface fractures to the cranial vault. Frontobasal fractures have three unique and reproducible patterns based on vector, location, and force. This new classification scheme, paired with known patterns of midfacial injuries, assists in fully understanding frontofaciobasal injury and its complications. Overwhelmingly, impure type II and any type III fractures are associated with a high rate of complications and must be carefully managed.

FRACTURES OF THE CLIVUS

We report the morbidity and mortality associated with fractures of the clivus and discuss management approaches specific to this unique diagnostic entity. We performed a boolean search of our electronic medical record database to identify patients with fractures of the clivus that were diagnosed using computed tomography of the head. A retrospective imaging and chart analysis was completed to further characterize the fractures and to analyze outcomes. Between January 1999 and December 2007, 41 patients were identified with fractures of the clivus. We found a 0.21% overall incidence among all head-injured patients presenting to our institution and a 2.3% incidence among those patients with a cranial fracture. Ten of 41 patients (24.4%) died, and neurological and vascular complications associated with central cranial base fractures were observed in 19 of 41 patients (46%). Furthermore, associated cranial fractures remote from the central cranial base and associated intracranial hemorrhages were observed in 40 of 41 (97.6%) and 33 of 41 (80.5%) patients, respectively. In terms of outcomes, 26 of 41 patients (63.5%) had a Glasgow Coma Scale score of 12 or greater at the time of discharge from the hospital. We demonstrate a lower than previously reported mortality rate in patients with clival fractures. Nevertheless, as a result of location, fractures of the clivus were frequently associated with a high rate of complications and neurological sequelae.

RESULTS OF ENDOVASCULAR TREATMENT OF TRAUMATIC INTRACRANIAL ANEURYSMS

To present results of early angiographic diagnosis and endovascular treatment of traumatic intracranial aneurysms (TICA). From June 2002 to December 2006, diagnostic angiography was performed on patients with moderate to severe traumatic brain injury that involved a cranial base fracture or a penetrating brain injury with a tract from the penetrating agent that entered at the pterional area, went through the middle cerebral artery candelabra, and crossed the midline. TICAs were treated by various endovascular techniques during the same angiographic procedure. Thirty-four patients with traumatic brain injury underwent angiography (25 penetrating brain injuries, nine blunt injuries); 13 TICAs were diagnosed (10 penetrating brain injuries, three blunt injuries). The Glasgow Coma Scale score at diagnosis ranged from 5 to 15. Angiography was performed for screening in eight patients and for clinical indications in five patients; 11 TICAs were diagnosed before rupture. Seven aneurysms were located on branches of the middle cerebral artery, two on pericallosal branches of the anterior cerebral artery, and four on the internal carotid artery. No recanalization was detected in 12 patients. One patient treated with a bare stent and coiling had a growing intracavernous pseudoaneurysm; therefore, internal carotid artery occlusion with extracranial-intracranial microvascular bypass was performed. Six patients refused angiographic follow-up, but computed tomographic angiography has failed to show recanalization. No patient presented with delayed bleeding (mean follow-up, 2.6 yr). There were no procedure-related complications or mortality. Early angiographic diagnosis with immediate endovascular treatment provided an effective approach for TICA detection and management. Endovascular therapy is versatile and offers a valuable alternative to surgery, allowing early aneurysm exclusion with excellent results.