0:01

Most of the time when we're considering vascular

0:03

injuries associated with the temporal bone,

0:06

we're able to make the diagnosis and do the evaluation with CTA.

0:10

So anytime you have a fracture of the temporal bone that enters

0:14

the petrous or cavernous portion of the internal carotid artery,

0:18

you want to get a CTA to see whether the vessel is bleeding,

0:22

whether it's dissected or whether it may have a contusion.

0:26

So, here is an example of a patient who has a fracture

0:29

entering the posterior portion of the petrous internal

0:32

carotid artery. And when you do the CTA,

0:37

you see that the carotid artery is missing.

0:40

So there's absence of flow. Here's the normal internal

0:43

carotid artery with contrast within it.

0:46

Here with the green arrow is internal

0:48

carotid artery with no contrast in it.

0:50

And you can see that there is thrombosis

0:54

of the right internal carotid artery.

0:56

We have a little stump here of the supraclinoid internal

0:59

carotid artery, secondary to thrombosis of the blood vessel.

1:03

Another one, fracture going across,

1:06

in this case an oblique oriented fracture.

1:09

But look at this short arrow and you see that their fracture

1:13

is involving the left cavernous internal carotid artery.

1:17

Little telltale sign of the air.

1:20

Here you have evidence of thrombosis of the transverse

1:24

sinus. Here's the normal transverse sinus.

1:26

This is likely secondary to the fracture involving

1:29

the mastoid portion of the temporal bone.

1:34

Here we have blood from, well,

1:38

this is extravasation of iodinated contrast from

1:41

small vessels at the external auditory canal.

1:44

So this is effectively blood products that is free streaming

1:48

into the region around the external auditory canal on the

1:51

left side, secondary to trauma from the fracture involving, in

1:56

this case, largely venous etiology as opposed to arterial

2:00

etiology. If you look at this internal carotid artery,

2:02

you want to see it on multiple sections.

2:04

It doesn't have the homogeneous enhancement,

2:07

and it looks like there's some thickening of the wall here.

2:10

This may be a traumatized carotid artery with dissection.

Complications of Temporal Bone Injury

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