Traumatic Intracranial Vascular Lesions in Adults Undergoing Vascular Imaging After Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Abstract

Background and Objectives: Traumatic intracranial vascular lesions are rare but severe complications of traumatic brain injury (TBI) and include arterial and venous injuries such as arterial dissections, pseudoaneurysms, arterial occlusions, venous sinus thrombosis, arteriovenous fistulas, and carotid–cavernous fistulas. Despite their clinical significance, the available literature remains limited and heterogeneous. This systematic review and meta-analysis aimed to evaluate the diagnostic yield of vascular imaging, spectrum, and imaging modalities of traumatic intracranial vascular lesions in adults with TBI. Materials and Methods: A systematic literature search was conducted from database inception to 31 August 2026 in PubMed, Web of Science Core Collection, Scopus, and the Cochrane Library (CENTRAL) according to the PRISMA 2020 guidelines. Cohorts of patients who underwent vascular imaging after TBI were eligible. When the full text was available, the denominator was the number of patients imaged with a modality able to detect the lesion in question and the numerator was reported at patient level for intracranial lesions. The primary analyses were restricted to cohorts with an explicit adult age criterion or a separately reported adult subgroup; cohorts with a pediatric fraction that could not be separated entered a sensitivity analysis only. Data extraction and quality assessment using the Newcastle–Ottawa Scale and the Joanna Briggs Institute checklist for prevalence studies were performed independently by two reviewers. Proportions were pooled with a logit-transformed random-effects model with restricted maximum-likelihood estimation and prediction intervals, with Freeman–Tukey and generalized linear mixed models as sensitivity analyses. Results: Nineteen studies with 3542 imaged patients were included, eight of them adult cohorts with 2021 patients. In adult cohorts, the pooled diagnostic yield was 11.0% (95% CI, 2.3–39.8%; four cohorts) for dural venous sinus thrombosis, 4.8% (95% CI, 1.1–18.4%; three cohorts) for pseudoaneurysm, 1.1% (95% CI, 0.0–20.8%; two cohorts) for arteriovenous fistula, and 0.7% (95% CI, 0.2–3.1%; three cohorts) for carotid–cavernous fistula, with I2 between 74.7% and 96.2% and prediction intervals spanning most of the possible range; arterial dissection (7.0%) and arterial occlusion (5.8%) were reported by a single adult cohort and were not pooled. The proportion of patients with any lesion was not pooled, because the seven cohorts that imaged every patient differed in whether and how the venous compartment was assessed; it ranged from 1.5% to 56.9% by cohort. Adding the eleven adult-dominant cohorts gave 17.5% for sinus thrombosis and 4.5% for pseudoaneurysm. In exploratory univariable meta-regressions for sinus thrombosis, trauma mechanism, imaging modality, and study design were each associated with part of the heterogeneity and were confounded with one another in these cohorts. Conclusions: Every estimate describes the yield of vascular imaging in adults selected for it, rests on two-to-four small cohorts, and carries very low certainty; the prediction intervals show that a new cohort may fall far from the pooled value, and none of the estimates can be read as the frequency of these lesions in TBI in general.