Management of vertebral artery injuries in civilian cervical gunshot wounds: A case series and literature review.

Cervical gunshot injuries, although rare, carry a significant risk of vertebral artery injuries (VAIs), which can lead to complex neurological and vascular complications. Effective management requires individualized strategies tailored to the clinical presentation and associated injuries. This study presents three cases of civilian cervical gunshot wounds involving VAIs and reviews the literature to highlight optimal management approaches. Three male patients, aged 24, 41, and 44, presented with cervical gunshot wounds and varying degrees of spinal cord and vertebral artery injuries. Two patients were managed conservatively with close monitoring, broad-spectrum antibiotics, and supportive care due to the absence of progressive neurological deficits or active bleeding. The third patient underwent emergency surgical decompression and vertebral artery clipping to control massive hemorrhage and prevent further neurological deterioration. Where feasible, endovascular treatment was prioritized due to its lower complication rates compared to open surgery. Follow-up revealed diverse outcomes, ranging from paraplegia to quadriparesis, highlighting the variable presentations and long-term consequences associated with these injuries. The third patient developed a delayed arteriovenous fistula (AVF) two years post-injury, which was successfully treated with endovascular embolization. Civilian cervical gunshot injuries involving the vertebral artery require individualized treatment plans. Conservative management may be appropriate for clinically stable cases, while surgical or endovascular interventions are crucial for managing vascular instability or progressive neurological deficits. Long-term follow-up is essential to detect and address delayed complications such as pseudoaneurysms or AVFs. This case series underscores the importance of a multidisciplinary approach, involving neurosurgery, vascular surgery, otolaryngology, and interventional radiology, to optimize outcomes and deliver comprehensive care.