Abstract
<title>Abstract</title> <p> <bold>Background</bold> Penetrating neck trauma poses a considerable threat to life due to the densely packed anatomy of vital neurovascular and aerodigestive structures. Accurate preoperative delineation of the spatial relationship between a penetrating object and adjacent critical structures is essential for surgical decision-making. <bold>Method</bold> In this report, we present two patients with complex penetrating injuries. Patient 1 sustained a stab wound to the neck and was managed with conventional non-contrast CT, which could not definitively exclude vascular contact, necessitating surgical exploration. Patient 2 sustained a transcranial-cervical-thoracic penetrating injury from a falling iron rod. Preoperative assessment included non-contrast multidetector CT and contrast-enhanced CTA with three-dimensional reconstruction, enabling visualization of the foreign body trajectory and its spatial relationship to major vessels, bones, and soft tissues within a unified three-dimensional model. <bold>Results</bold> In Patient 2, CTA confirmed vascular integrity, and three-dimensional reconstruction demonstrated that the iron rod was not in contact with major arteries. This preoperative spatial assessment guided the multidisciplinary team to adopt a direct extraction strategy under controlled conditions, thereby avoiding unnecessary cervical exploration. In Patient 1, the absence of contrast-enhanced vascular imaging precluded definitive exclusion of vascular contact, and surgical exploration was performed to verify vascular integrity. <bold>Conclusions</bold> Preoperative CTA with three-dimensional reconstruction may serve as a useful adjunct for surgical planning in selected, complex penetrating injuries by providing spatial information on the relationship between foreign bodies and critical neurovascular structures. Our illustrative cases suggest that comprehensive preoperative imaging assessment can support selective, multidisciplinary management strategies; however, its impact on clinical outcomes requires validation in larger cohorts. </p>