Penetrating intracranial nail-gun injury to the middle cerebral artery: A successful primary repair

Thirty-two nails injected into the head: An operative report and review of the literature

Background:

Self-inflicted nail gun injuries are a rare phenomenon that can result in traumatic damage. The velocity of the nail is generally fast enough to penetrate the skull. However, the extent of damage depends on the exact angle and structures of the brain encountered by the nails.

Case Description:

A 55-year-old male presented with 32 nails in the head and was found down. Initially, the patient presented with localization but had to be intubated soon after due to declining condition. This report describes the operative technique for safe removal of all nails, separated into six categories based on location and structures of the brain encountered. A review of literature revealed potential complications such as hemorrhage and infections and how to protect against these undesired effects.

Conclusion:

Self-inflicted nail gun head injuries are an uncommon form of traumatic head injury. Some important tools that helped prevent our patient from developing major complications included stereotactic navigation, antibiotic prophylaxis, and angiography to carefully monitor for vascular injuries.

Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note

We report a 45-year-old man who suffered a penetrating nail gun injury resulting in damage to the lateral edge of the superior sagittal sinus. The injury was successfully treated via a parasagittal craniotomy that enabled removal of the nail under direct vision, allowing for rapid suturing of the sagittal sinus. Two neurosurgeons worked together; one carefully withdrew the tip of the nail back into the sinus itself while the second rapidly sutured the hole in the inner superior sagittal sinus leaflet. Postoperatively, the patient made a rapid recovery without neurological deficit.

Diagnosis and treatment of a penetrating brain injury caused by a welding electrode: A case report

RATIONALE

Penetrating brain injury caused by a welding electrode is a rare occurrence. This type of injury requires careful preoperative assessment and timely treatment measures to avoid secondary damage.

PATIENT CONCERNS

A 55-year-old male patient fell from a height of approximately 5 m during when a welding electrode in his left hand was inadvertently inserted into his brain. The patient had a GCS score of 15 and complaints of dizziness and headache. CT showed an object of metallic density penetrating the skull and entering the brain parenchyma in the frontotemporal region.

DIAGNOSIS

According to the clinical findings and preoperative imaging examination, the diagnosis was open craniocerebral injury with intracranial foreign body and left orbital wall fracture.

INTERVENTION

After definite diagnosis and sufficient preoperative preparation, active surgical treatment was carried out to remove intracranial foreign body. Anti-infection and other symptomatic treatment were given after operation. The signs of infection and changes of vital signs were closely observed.

OUTCOMES

After treatment, no obvious adverse reactions were found and the patient was discharged. No complications such as infection occurred during the follow-up period of 6 months.

LESSONS

In treating patient with a welding electrode penetrating the brain, assessments need to be made preoperatively, the welding electrode needs to be removed in a timely manner, complete hemostasis needs to be achieved during surgery with total repair of the damaged area, and anti-inflammatory treatment needs to be administered postoperatively to achieve good results.

Foreign body in the thoracic spine due to a nail gun penetrating injury: A case report

RATIONALE

Spinal cord injuries could be catastrophic because they may result in severe neurovascular complications. Here, we present a case of thoracic spine-penetrating injury by a nail-gun.

PATIENT CONCERNS

A 60-year-old male presented to our emergency department with complaints of progressive right chest pain for 1 week that was preceded by back pain. He had a medical history of hypertension and denied any trauma history. He had alert consciousness and stable vital signs. He was a carpenter. Upon physical and neurological examination, no obvious wounds or vesicle formation were noted, and the patient was neurologically intact.

DIAGNOSIS

Laboratory test results showed abnormally elevated D-dimer levels. Electrocardiography showed normal sinus rhythm. Chest radiography showed no mediastinal widening. Chest computed tomography was performed. The formal radiology report indicated a foreign body in the T4-5 spinal cord and upper back.

INTERVENTIONS

A neurosurgeon was consulted with suggestion of operation. We performed T4-5 laminectomy and foreign body removal. The foreign body, stuck to the spinal cord with dural rupture, was removed and found to be a 5 cm-long broken nail.

OUTCOMES

The pain resolved immediately post operation.

LESSONS

Surgical removal of the foreign body is recommended if neurovascular complications or cerebrospinal fluid (CSF) leak is detected. Obtaining the patient's complete history, including occupation, might be helpful in determining the diagnosis. Careful interpretation of diagnostic imaging is necessary for avoiding medical disputes. Even in the absence of wounds and ecchymosis, trauma-related injury should be considered.