Traumatic brain injury with carotid canal penetrating wound.

Patient male, victim of aggression, comatose, with a screwdriver in his ear canal (Figure 1). CT scan showed a route of the screwdriver through the temporal petrous portion, through the internal carotid artery (ICA) course and a subdural hematoma (Figure 2). We performed hematoma evacuation, with subsequently intracranial and cervical ICA temporary clipping. We removed the screwdriver without bleeding (Figure 3). A postoperative angiography showed no vascular lesions (Figure 4). In the patient discharge, he had severe disability (Glasgow outcome scale 3). In these cases there is high risk for bleeding. So, we believe that combined approach should be performed for safe removal of this penetrating body.