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Assoumane II, Agada NK, Maman Sani R, Kélani A. Penetrating Head Injury by a Hit of Rake in a Child: A Case Report and Literature Review. Case Rep Neurol Med 2023; 2023:9921985. [PMID: 38025302 PMCID: PMC10676273 DOI: 10.1155/2023/9921985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/08/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Background A penetrating head injury (PHI) refers to a situation where a projectile has breached the cranium but does not exit it. It constitutes about 0.4% of all head injuries. Several nonmissile materials inserting the skull have been reported. But to our knowledge, never before has any case of PHI caused by a hit of rake been reported. We report a first case of PHI caused by a rake in a child; then, we relate our experience with its management and discuss the relevant literature. Cases Description. A 5-year-old boy has been admitted with a rake embedded in his head. That occurred during a violent play with a neighbor. At presentation, the child was alert; there was no neurological deficit. The rake was embedded in the parietal regions on each side of the midline. The head Computed Tomography (CT) scan performed showed a biparietal hyperdensity from either side of the midline with a metal artifact. In the operating room, after a transversal incision joining the 2 tips of the object, we performed successively bone flaps; object extraction; debridement; duraplasty; and closing. The outcome was uneventful. Conclusion This is the first case of PHI by a rake. The surgical management constitutes the main challenging point.
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Affiliation(s)
- Issa Ibrahim Assoumane
- Niamey National Hospital, Niamey, Niger
- Faculty of Health Sciences of Abdou Moumouni University of Niamey, Niamey, Niger
| | - Nicaise Kpègnon Agada
- Niamey National Hospital, Niamey, Niger
- Faculty of Health Sciences of Abdou Moumouni University of Niamey, Niamey, Niger
| | - Rabiou Maman Sani
- Zinder National Hospital, Zinder, Niger
- Faculty of Health Sciences of University of Zinder, Zinder, Niger
| | - Aminath Kélani
- Niamey National Hospital, Niamey, Niger
- Faculty of Health Sciences of Abdou Moumouni University of Niamey, Niamey, Niger
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2
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Abdulsada AM, Ismail M, Elsayed AM, Emara MR, Al-Khazaali YM, Albairmani SS, Muthana A, Hoz SS. Stephanion to cranial base penetrating stab wound with outstanding recovery: A case report. Surg Neurol Int 2023; 14:72. [PMID: 36895221 PMCID: PMC9990633 DOI: 10.25259/sni_962_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/11/2023] [Indexed: 02/26/2023] Open
Abstract
Background Mortality due to head trauma is common in developed countries in all age groups. Nonmissile penetrating skull base injuries (PSBIs) due to foreign bodies are quite rare, accounting for about 0.4%. PSBI carries that a poor prognosis brainstem involvement usually is often fatal. We are reporting the first case of PSBI with a foreign body insertion site through the stephanion with a remarkable outcome. Case Description The 38-year-old male patient was referred with a penetrating stab wound to the head through the stephanion caused by a knife after a conflict in the street. He had no focal neurological deficit or cerebrospinal fluid leak, and Glasgow coma scale (GCS) was 15/15 on admission. A preoperative computed tomography scan showed the path of the stab beginning at the stephanion, which is the point where the coronal suture crosses the superior temporal line, heading toward the cranial base. Postoperatively, GCS was 15/15 without any deficit apart from the left wrist drop, possibly due to a left arm stab. Conclusion Careful investigations and diagnoses must be made to ensure convenient knowledge of the case due to the variety of injury mechanisms, foreign body characteristics, and individual patients' characteristics. Reported cases of PSBIs in adults have not reported a stephanion skull base injury. Although brain stem involvement is usually fatal, our patient had a remarkable outcome.
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Affiliation(s)
| | - Mustafa Ismail
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | - Mohamed R Emara
- University of Sharjah, College of Medicine, Sharjah, United Arab Emirates
| | - Younus M Al-Khazaali
- Department of Neurosurgery, University of Al-Nahrain, College of Medicine, Baghdad, Iraq
| | - Sama S Albairmani
- Department of Neurosurgery, University of Al-Iraqia, College of Medicine, Baghdad, Iraq
| | - Ahmed Muthana
- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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3
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Tse MF, Huang SH, Tsai YH, Li CH. Non-missile penetrating brain injury-surgical techniques for removing a long penetrating foreign body: a case report. Br J Neurosurg 2022:1-4. [PMID: 36583395 DOI: 10.1080/02688697.2022.2159926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Penetrating brain injury (PBI), a relatively uncommon injury, is associated with remarkable secondary complications such as vascular injury, intracranial haemorrhage, infection, and mortality. Non-missile PBI (NMPBI) due to sharp or blunt objects is usually treated surgically by removing the penetrating object, evacuating the associated haemorrhage, identifying possible bleeders along with haemostasis, and performing debridement. Various approaches are used for different scenarios of non-missile PBI according to the object's characteristics, penetrating site, depth, associated intracerebral haemorrhage (ICH), and presence of vascular injury along the penetrating tract. NMPBI cases are rarely reported among civilians. We herein describe a patient who was successfully treated for NMPBI, as well as frontal ICH, by simultaneously removing the heavy, metallic penetrating foreign body. METHODS We performed corticotomy through a shorter tract instead of a deep penetrating trajectory, which minimizes the extent of damage to the brain and enables immediate management of vascular injury under direct vision while removing the foreign body, and intraoperative sonography, which provides real-time information of the penetrating object and the surrounding brain structure. We did not perform computed tomography angiography and digital subtraction angiography (DSA) because the stab location was at the frontal region, with low risk of vascular injury. Moreover, DSA is time-consuming, which may delay decompressive surgery. RESULTS The patient was successfully treated through an alternative approach removing the long, heavy, metallic penetrating foreign body and eliminating the accompanying frontal ICH simultaneously. Focal brain abscess developed 8 days after the injury and resolved completely after antibiotics treatment. Dysphasia gradually improved but right distal limbs weakness with spasticity is still present. CONCLUSIONS Our findings suggest prompt diagnosis by preoperative imaging, screening of vascular injury, decompression with debridement, and antibiotics treatment are important. The alternative surgical approach we proposed is exceptional and should be considered while treating patients with deep NMPBI.
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Affiliation(s)
- Ming-Fai Tse
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Shih-Hao Huang
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Yi-Hsin Tsai
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chien-Hsun Li
- Department of Surgery, Division of Neurosurgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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4
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Yousif RS, Omar AM, Ismail M, Hamouda WO, Alkhafaji AO, Hoz SS. Excellent recovery after nonmissile penetrating traumatic brain injury in a child: A case report. Surg Neurol Int 2022; 13:388. [PMID: 36128089 PMCID: PMC9479510 DOI: 10.25259/sni_350_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury. Case Description: We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull base zone. Conclusion: We demonstrated that following standard recommendations in the management of pTBI which include applying the advanced trauma life support protocol in ER, acquiring the needed preoperative neuroimaging studies, avoiding moving the penetrating object till patient shifted to OR, and finally performing a planned stepwise surgical intervention through craniotomy may yield an excellent functional recovery, especially in children despite an otherwise grave initial presentation and apparently profound brain injury.
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Affiliation(s)
- Reber S. Yousif
- Department of Neurosurgery, Emergency Teaching Hospital, Duhok, Iraq,
| | - Alend M. Omar
- Department of Neurosurgery, Emergency Teaching Hospital, Duhok, Iraq,
| | - Mustafa Ismail
- College of Medicine, University of Baghdad, Baghdad, Iraq,
| | - Waeel O. Hamouda
- Department of Neurosurgery, Kasr Alainy School of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt,
- Department of Neurological and Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia,
| | | | - Samer S. Hoz
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States
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5
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Schlag H, Neuhoff J, Castein J, Hoffmann C, Kandziora F. Rupture of the Superior Sagittal Sinus in Penetrating Head Injury-Management of a Rare Trauma Mechanism. J Neurol Surg Rep 2022; 83:e3-e7. [PMID: 35028277 PMCID: PMC8747896 DOI: 10.1055/s-0041-1742103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Civilian penetrating head injury caused by foreign objects is rare in Germany (Europe), but can result in complex neurovascular damage. We report on a patient who in suicidal intent inflicted on himself a penetrating brain injury near the vertex with a captive bolt gun. A laceration at the junction of the middle to the posterior third of the superior sinus occurred by bolt and bone fragments leading to critical stenosis and subsequent thrombosis. Upon surgery, the proximal and distal sinus openings were completely thrombosed. The sinus laceration was closed by suture and the intraparenchymal bone fragments were retrieved. Postoperative angiography disclosed persistent occlusion of the superior sagittal sinus. The patient did not develop any symptoms due to venous congestion (edema, hemorrhage), suggesting sufficient collateral venous outflow. The patient completely recovered despite the complexity of the lesion.
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Affiliation(s)
- Holger Schlag
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main GmbH, Germany
| | - Jonathan Neuhoff
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main GmbH, Germany
| | - Jens Castein
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main GmbH, Germany
| | - Christoph Hoffmann
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main GmbH, Germany
| | - Frank Kandziora
- Centre for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main GmbH, Germany
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6
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Harrington BM, Gretschel A, Lombard C, Lonser RR, Vlok AJ. Complications, outcomes, and management strategies of non-missile penetrating head injuries. J Neurosurg 2021; 134:1658-1666. [PMID: 32559744 DOI: 10.3171/2020.4.jns20122] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While high-velocity missile injury (gunshot) is associated with kinetic and thermal injuries, non-missile penetrating head injury (NMPHI) results in primary damage along the tract of the piercing object that can be associated with significant secondary complications. Despite the unique physical properties of NMPHI, factors associated with complications, expected outcomes, and optimal management have not been defined. In this study, the authors attempted to define those factors. METHODS Consecutive adult patients with NMPHI who presented to Tygerberg Academic Hospital (Cape Town, South Africa) in the period from August 1, 2011, through July 31, 2018, were enrolled in a prospective study using a defined treatment algorithm. Clinical, imaging, and laboratory data were analyzed. RESULTS One hundred ninety-two patients (185 males [96%], 7 females [4%]) with 192 NMPHIs were included in this analysis. The mean age at injury was 26.2 ± 1.1 years (range 18-58 years). Thirty-four patients (18%) presented with the weapon in situ. Seventy-one patients (37%) presented with a Glasgow Coma Scale (GCS) score of 15. Weapons included a knife (156 patients [81%]), screwdriver (18 [9%]), nail gun (1 [0.5%]), garden fork (1 [0.5%]), barbeque fork (1 [0.5%]), and unknown (15 [8%]). The most common wound locations were temporal (74 [39%]), frontal (65 [34%]), and parietal (30 [16%]). The most common secondary complications were vascular injury (37 patients [19%]) and infection (27 patients [14%]). Vascular injury was significantly associated with imaging evidence of deep subarachnoid hemorrhage and an injury tract crossing vascular territory (p ≤ 0.05). Infection was associated with delayed referral (> 24 hours), lack of prophylactic antibiotic administration, and weapon in situ (p ≤ 0.05). A poorer outcome was associated with a stab depth > 50 mm, a weapon removed by the assailant, vascular injury, and eloquent brain involvement (p ≤ 0.05). Nineteen patients (10%) died from their injuries. The Glasgow Outcome Scale (GOS) score was linearly related to the admission GCS score (p < 0.001). One hundred forty patients (73%) had a GOS score of 4 or better at discharge. CONCLUSIONS The most common NMPHI secondary complications are vascular injury and infection, which are associated with specific NMPHI imaging and clinical features. Identifying these features and using a systematic management paradigm can effectively treat the primary injury, as well as diagnose and manage NMPHI-related complications, leading to a good outcome in the majority of patients.
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MESH Headings
- Adolescent
- Adult
- Brain Abscess/etiology
- Cerebral Angiography
- Craniotomy/methods
- Disease Management
- Female
- Glasgow Coma Scale
- Glasgow Outcome Scale
- Head Injuries, Penetrating/complications
- Head Injuries, Penetrating/diagnostic imaging
- Head Injuries, Penetrating/surgery
- Head Injuries, Penetrating/therapy
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/etiology
- Hematoma, Subdural/therapy
- Humans
- Male
- Middle Aged
- Prospective Studies
- Risk
- Subarachnoid Hemorrhage, Traumatic/diagnostic imaging
- Subarachnoid Hemorrhage, Traumatic/etiology
- Subarachnoid Hemorrhage, Traumatic/therapy
- Weapons
- Wound Infection/etiology
- Young Adult
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Affiliation(s)
| | | | - Carl Lombard
- 2Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Western Cape, South Africa; and
| | - Russell R Lonser
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adriaan J Vlok
- 1Division of Neurosurgery, University of Stellenbosch; and
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7
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Yu SDPM, Lau JSK, Chau YM, Kan PG. Fencing unmasked: A case of penetrating cranio-orbital injury. HONG KONG J EMERG ME 2021. [DOI: 10.1177/1024907919855158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Transorbital low-velocity penetrating head injuries are uncommon but important. Minor skin wounds may herald intracranial injury with high morbidity and mortality. Case presentation: A fencing coach was pierced by a sabre between his nose and right eye resulting in orbital roof fracture and frontal lobe laceration. With prompt recognition of these injuries under multidisciplinary management, he attained uncomplicated recovery. Conclusion: The emergency physician should maintain a high index of suspicion for intracranial injury in patients presenting with history of penetrating head injury. Understanding orbital anatomy, injury mechanisms and patterns can facilitate timely management to prevent potentially sight-threatening and life-threatening complications.
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Affiliation(s)
| | - James Siu Ki Lau
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
| | - Yau Ming Chau
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
| | - Pui Gay Kan
- Accident and Emergency Department, Ruttonjee Hospital, Wan Chai, Hong Kong
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8
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Penetrating brain trauma through a metal bar extracted at home: An unusual case. Neurochirurgie 2021; 67:636-638. [PMID: 33493540 DOI: 10.1016/j.neuchi.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/25/2020] [Accepted: 01/13/2021] [Indexed: 11/24/2022]
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9
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Burns TG, Semmel ES, Reisner A. A longitudinal evaluation of a penetrating traumatic brain injury: Theories of plasticity and vulnerability. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:881-886. [PMID: 32546024 DOI: 10.1080/23279095.2020.1780239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Penetrating traumatic brain injury (TBI) is uncommon in infancy. The consequences may be devastating, especially when the injury is extensive and affects eloquent areas of the brain. There is the potential for neuropsychological dysfunction that may impact the individual's development and well-being into adulthood. In the context of early brain injury, the developing brain is both remarkably resilient and vulnerable. The present case study describes a patient who experienced a penetrating TBI at 9 days of age, subsequently developed intractable seizures, and underwent left hemispherectomy. Neuropsychological testing at ages 5, 10, 11, and 19 years are presented alongside fMRI and Wada testing. While the patient initially developed cognitive functions in the low-average range by age 5, scores on neuropsychological assessments began to decrease thereafter. This case is discussed with attention to vulnerability and plasticity theories. It highlights the ability of the brain to reorganize and allow the development of functions that would normally be sub-served by damaged areas and the limits of plasticity. Further, this case illustrates the vulnerability of the early brain to insult, the potential to grow into deficits, and the need to consider a variety of factors when predicting outcomes for cases of pediatric brain injury.
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Affiliation(s)
- Thomas G Burns
- Department of Neuropsychology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Eric S Semmel
- Department of Psychology & The Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Andrew Reisner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA.,Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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10
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Lindfors M, Lindblad C, Nelson DW, Bellander BM, Siironen J, Raj R, Thelin EP. Prognostic performance of computerized tomography scoring systems in civilian penetrating traumatic brain injury: an observational study. Acta Neurochir (Wien) 2019; 161:2467-2478. [PMID: 31659439 PMCID: PMC6874621 DOI: 10.1007/s00701-019-04074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/13/2019] [Indexed: 01/21/2023]
Abstract
Background The prognosis of penetrating traumatic brain injury (pTBI) is poor yet highly variable. Current computerized tomography (CT) severity scores are commonly not used for pTBI prognostication but may provide important clinical information in these cohorts. Methods All consecutive pTBI patients from two large neurotrauma databases (Helsinki 1999–2015, Stockholm 2005–2014) were included. Outcome measures were 6-month mortality and unfavorable outcome (Glasgow Outcome Scale 1–3). Admission head CT scans were assessed according to the following: Marshall CT classification, Rotterdam CT score, Stockholm CT score, and Helsinki CT score. The discrimination (area under the receiver operating curve, AUC) and explanatory variance (pseudo-R2) of the CT scores were assessed individually and in addition to a base model including age, motor response, and pupil responsiveness. Results Altogether, 75 patients were included. Overall 6-month mortality and unfavorable outcome were 45% and 61% for all patients, and 31% and 51% for actively treated patients. The CT scores’ AUCs and pseudo-R2s varied between 0.77–0.90 and 0.35–0.60 for mortality prediction and between 0.85–0.89 and 0.50–0.57 for unfavorable outcome prediction. The base model showed excellent performance for mortality (AUC 0.94, pseudo-R2 0.71) and unfavorable outcome (AUC 0.89, pseudo-R2 0.53) prediction. None of the CT scores increased the base model’s AUC (p > 0.05) yet increased its pseudo-R2 (0.09–0.15) for unfavorable outcome prediction. Conclusion Existing head CT scores demonstrate good-to-excellent performance in 6-month outcome prediction in pTBI patients. However, they do not add independent information to known outcome predictors, indicating that a unique score capturing the intracranial severity in pTBI may be warranted. Electronic supplementary material The online version of this article (10.1007/s00701-019-04074-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matias Lindfors
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, PB 266, 00029, Helsinki, Finland.
| | - Caroline Lindblad
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David W Nelson
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Bo-Michael Bellander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Theme Neuro, Karolinska University Hospital, Stockholm, Sweden
| | - Jari Siironen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, PB 266, 00029, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Topeliuksenkatu 5, PB 266, 00029, Helsinki, Finland
| | - Eric P Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- Theme Neuro, Karolinska University Hospital, Stockholm, Sweden
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11
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Miller M, Newberry I, Ho W, Brockmeyer D, Smith M. The Luckiest Girl in the World: Transpalatal penetration of the brain by a knitting needle without major injury. INT J PEDIAT OTO CAS 2019. [DOI: 10.1016/j.pedeo.2019.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Ebeling PA, Ghali AN, McDermott R, Caron JLR, Dent DL. Survival After a Transcranial Bihemispheric Stabbing with a Knife: Case Report and Literature Review. Cureus 2019; 11:e5512. [PMID: 31687288 PMCID: PMC6818735 DOI: 10.7759/cureus.5512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022] Open
Abstract
Low-velocity penetrating brain injuries (PBIs), also referred to as nonmissile brain injuries, typically result from stabbings, industrial or home accidents, or suicide attempts. A great deal of literature has focused on the injury patterns and management strategies of high-velocity PBIs. However, there are substantially fewer large, contemporary studies focused solely on low-velocity PBIs. Here, we present an interesting and uncommon case of a patient who suffered a bihemispheric stab wound involving the basal ganglia. A 22-year-old man presented to the hospital with a stab wound to the left calvarium. His initial Glasgow Coma Scale (GCS) score was 13, but he rapidly declined to a six and was intubated. He was emergently taken to the operating room for craniectomy, knife removal, and external ventricular drain placement. On the first postoperative day, the patient was following commands with all extremities. He was discharged to a rehabilitation facility 13 days postinjury. One year after the injury, the patient was free of major neurologic sequelae. This report illustrates a rare case of a good functional outcome after a transcranial stabbing with multiple imaging and exam findings usually associated with poor outcomes.
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Affiliation(s)
- Peter A Ebeling
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Abdullah N Ghali
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Ryan McDermott
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Jean-Louis R Caron
- Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Daniel L Dent
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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13
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Occult Transorbital Intracranial Injury by Windshield Wiper Handle: Case Report and Review of Literature. World Neurosurg 2019; 126:530-532. [PMID: 30904801 DOI: 10.1016/j.wneu.2019.02.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/25/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND We present the case of a 51-year-old male with an occult transorbital intracranial injury after a car accident. The identified foreign object was a windshield wiper handle. To our knowledge, this is the first case reported. CASE DESCRIPTION Multidisciplinary treatment with maxillofacial and otorhinolaryngology departments was planned. A bifrontal craniotomy with removal of the foreign object and posterior orbital reconstruction were performed. A review of the literature was done, in order to highlight certain general principles in decision making despite the variability in case presentation. CONCLUSIONS Occult TII is a rare subtype of penetrating brain injury. Diagnosis requires high suspicion as it can be missed during physical examination. Computed tomography (CT) scan, CT angiogram, and magnetic resonance imaging should be performed in order to design the optimal treatment for each patient. Magnetic resonance imaging should be avoided when metallic density on CT is observed. The use of a broad-spectrum antibiotic regimen is critical.
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14
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O'Connor KP, Palejwala AH, Briggs RG, Massoth L, Argo JL, Glenn CA. Use of Pterional Craniotomy for Removal of Penetrating Object: Case Report and Surgical Video. World Neurosurg 2019; 126:21-23. [PMID: 30825621 DOI: 10.1016/j.wneu.2019.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Penetrating injuries are dangerous because they can damage intracranial structures. Removal of the object carries this same risk of injury, so neurosurgeons often visualize the injury via craniotomy during removal. CASE DESCRIPTION This report illustrates the case of a 41-year-old man who had a penetrating injury with a knife that started in the left nasal passage and extended to the parasellar region. Computed tomography angiography revealed an associated sphenoid fracture and showed the tip of the knife within the parasellar space with preservation of the internal carotid artery, ophthalmic artery, optic nerve, and pituitary gland. The patient was taken to the operating room for a right pterional craniotomy and the knife was removed in the operating room in a combined effort between neurosurgery and otorhinolaryngology. CONCLUSIONS The patient progressed well without complications postoperatively and was discharged 5 days later. We provide a report with video showing our surgical approach for removal of a penetrating object through the tuberculum sellae.
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Affiliation(s)
- Kyle P O'Connor
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ali H Palejwala
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Robert G Briggs
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Landon Massoth
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jimmy L Argo
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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15
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Drosos E, Giakoumettis D, Blionas A, Mitsios A, Sfakianos G, Themistocleous M. Pediatric Nonmissile Penetrating Head Injury: Case Series and Literature Review. World Neurosurg 2018; 110:193-205. [DOI: 10.1016/j.wneu.2017.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Awori J, Wilkinson DA, Gemmete JJ, Thompson BG, Chaudhary N, Pandey AS. Penetrating Head Injury by a Nail Gun: Case Report, Review of the Literature, and Management Considerations. J Stroke Cerebrovasc Dis 2017; 26:e143-e149. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 04/03/2017] [Indexed: 11/26/2022] Open
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Morita T, Maki Y, Yamada D, Ishibashi R, Chin M, Yamagata S. External Ventricular Drainage Preceding the Removal of a Nail from the Intracranial Space as a Safe Management Strategy for Predicted Secondary Intraventricular Hemorrhage. World Neurosurg 2017; 106:1056.e9-1056.e13. [PMID: 28755920 DOI: 10.1016/j.wneu.2017.07.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intracranial nail gun injury is a rare traumatic event and can result from a suicide attempt. Cerebral angiography is essential in the evaluation of damage to the intracranial vessels, and surgical removal of nails is generally the optimal treatment. Intraventricular hemorrhage can happen after removal of intracranial nails. Endovascular surgery or intraoperative computed tomography has been reported to be useful for detection and treatment of intraventricular hemorrhage. After the surgical removal of nails, attention should be paid for complications such as pseudoaneurysm and infection. CASE DESCRIPTION A 63-year-old man with a history of depression was transferred to our hospital in an unconscious state. Physical examination showed 2 nails puncturing his left thorax, and computed tomography revealed a nail puncturing the intracranial space. No damage to these intracranial vessels was observed on computed tomography angiography and venography. After drainage for potential intraventricular hemorrhage, the nails were removed. Postoperatively, prophylactic antibiotic therapy was administrated for secondary infection. Computed tomography angiography did not detect any postoperative pseudoaneurysms. The patient also underwent therapy from a psychiatrist and was transferred to another hospital. CONCLUSIONS As for treatment of a case of intracranial nail gun injury, our case shows that preoperative cerebral angiography is not always needed in intracranial nail gun injury when there is no apparent damage to the intracranial vessels and emergent removal of nails is required. External ventricular drainage preceding the removal of a puncture object can be an effective management strategy for secondary intraventricular hemorrhage.
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Affiliation(s)
- Takumi Morita
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
| | - Yoshinori Maki
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Daisuke Yamada
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
| | - Sen Yamagata
- Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
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18
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Rzaev DA, Danilin VE, Letyagin GV, Istomina TK, Chishchina NV. [Penetrating orbitocranial injury: a review of the literature and a case report of injury by a watercolor brush in a 3-year-old child]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:77-87. [PMID: 28524129 DOI: 10.17116/neiro201781277-87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a rare case of orbitocranial penetrating injury by a watercolor brush in a 3-year-old child. Injuries of this localization can affect important orbital structures (eyeball, blood vessels, nerves, muscles) and cause severe intracranial damages. In some cases, diagnosis of these injuries in children may be difficult due to the lack of marked clinical manifestations. The presented clinical case illustrates the approaches for choosing methods for diagnosis of injury in childhood and subsequent treatment options.
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Affiliation(s)
- D A Rzaev
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | - V E Danilin
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | - G V Letyagin
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | - T K Istomina
- Federal Center of Neurosurgery, Novosibirsk, Russia
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Shi J, Mao Y, Cao J, Dong B. Management of screwdriver-induced penetrating brain injury: a case report. BMC Surg 2017; 17:3. [PMID: 28068964 PMCID: PMC5223301 DOI: 10.1186/s12893-016-0195-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Penetrating brain injury (PBI) can be caused by several objects ranging from knives to chopsticks. However, an assault with long and electric screwdriver is a peculiar accident and is relatively rare. Because of its rarity, the treatments of such injury are complex and nonstandardized. Case presentation We presented a case of a 54-year-old female who was stabbed with a screwdriver in her head and accompanied by loss of consciousness for 1 h. Computer tomography (CT) demonstrated that the screwdriver passed through the right zygomatic bone to posterior cranial fossa. Early foreign body removal and hematoma evacuation were performed and the patient had a good postoperative recovery. Conclusions In this study, we discussed the clinical presentation and successful management of such a unique injury caused by a screwdriver. Our goal is to demonstrate certain general management principles which can improve patient outcomes.
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Affiliation(s)
- Jia Shi
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Yumin Mao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Jiachao Cao
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China
| | - Bo Dong
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003, China.
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20
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Del Castillo-Calcáneo JD, Bravo-Angel U, Mendez-Olan R, Rodriguez-Valencia F, Valdés-García J, García-González U, Broc-Haro GG. Traumatic brain injury with a machete penetrating the dura and brain: Case report from southeast Mexico. Int J Surg Case Rep 2016; 23:169-72. [PMID: 27156252 PMCID: PMC5022070 DOI: 10.1016/j.ijscr.2016.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 04/20/2016] [Accepted: 04/24/2016] [Indexed: 11/18/2022] Open
Abstract
We present the first case of a penetrating non missile cranial injury with a machete in Mexico. The case was managed in accordance to current algorithms presented in the literature for the management of non-missile penetrating (NMP) cranial injuries, ultimately requiring a decompressive craniectomy, with good outcome. The use of current algorithms for managing NMP cranial trauma has proved to be very useful when applied on this particular case. Glasgow Coma Scale on admission is an important prognostic factor in NMP cranial trauma.
Introduction Traumatic Brain Injury (TBI) is a major cause of death and disability in our society, we present the first case report of non-missile penetrating (NMP) cranial trauma with a machete in Mexico, and our objective by presenting this case is to prove the usefulness of recently proposed algorithms in the treatment of NMP Presentation of case We present the case of a 47 year old woman who received a machete hit to the right side of her head during an assault., she arrived fully conscious to the emergency department (ED), computed tomography was performed and based on the findings of this study and in accordance to recently proposed algorithms for managing NMP cranial trauma a craniotomy was performed, at follow-up the patient presented wtih minor neurological disability in the form of left hemiparesis. Discussion Non-missile penetrating (NMP) lesions are defined as having an impact velocity of less than 100 m/s, causing injury by laceration and maceration, An algorithm for treating NMP cranial trauma has been recently published in the Journal World Neurosurgery by De Holanda et al., in this case we followed the algorithm in order to provide best care available for our patient with good results. Conclusion The use of current algorithms for managing NMP cranial trauma has proved to be very useful when applied on this particular case. GCS on admission is an important prognostic factor in NMP cranial trauma.
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Affiliation(s)
- Juan D Del Castillo-Calcáneo
- Neurosurgery, National Autonomous University of Mexico (UNAM), Mexico City, Mexico; Neurosurgery Department, Mexican Oil Company (Pemex) High Specialty Hospital, Mexico City, Mexico.
| | - Ulises Bravo-Angel
- Neurosurgery Department, Mexican Oil Company (Pemex) Regional Hospital, Villahermosa, Tabasco, Mexico; Neurosurgery Department, Social Security Institute of Tabasco (ISSET) Medical Specialty Center "Julian A Manzur Ocaña", Villahermosa, Tabasco, Mexico
| | - Raúl Mendez-Olan
- Neurosurgery Department, Mexican Oil Company (Pemex) Regional Hospital, Villahermosa, Tabasco, Mexico
| | | | - Javier Valdés-García
- Neurosurgery Department, Social Security Institute for State Workers (ISSSTE) López Mateos Regional Hospital, Mexico City, Mexico
| | - Ulises García-González
- Neurosurgery, National Autonomous University of Mexico (UNAM), Mexico City, Mexico; Neurosurgery Department, Mexican Oil Company (Pemex) High Specialty Hospital, Mexico City, Mexico; Neurosurgery Department, The American British Cowdray Hospital, Mexico City, Mexico
| | - Guy G Broc-Haro
- Neurosurgery, National Autonomous University of Mexico (UNAM), Mexico City, Mexico; Neurosurgery Department, The American British Cowdray Hospital, Mexico City, Mexico; Neurosurgery Department, Social Security Institute for State Workers (ISSSTE) López Mateos Regional Hospital, Mexico City, Mexico
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