Treatment of Penetrating Nonmissile Traumatic Brain Injury. Case Series and Review of the Literature

• Published in: World neurosurgery 2016-07, Vol.91, p.297-307
• Main Authors: Zyck, Stephanie, Toshkezi, Gentian, Krishnamurthy, Satish, Carter, David A, Siddiqui, A, Hazama, Ali, Jayarao, Mayur, Chin, Lawrence
• Format: Article
• Language: English
• Subjects: Adult; Angiography, Digital Subtraction; Brain - surgery; Brain Injuries, Traumatic - surgery; Child; Computed Tomography Angiography; Craniotomy - methods; Foreign Bodies - surgery; Foreign body; Head Injuries, Penetrating - surgery; Humans; Intracranial; Male; Middle Aged; Neurosurgery; Neurotrauma; Penetrating brain injury; Self-Injurious Behavior - surgery; Tomography, X-Ray Computed; Traumatic brain injury; Wounds, Stab - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.04.012

Abstract Introduction Penetrating traumatic brain injuries, with the exception of gunshot wounds, are relatively rare occurrences and affect all ages. Clinical presentation varies depending on the mechanism of the injury. Prompt surgical treatment is often indicated and is influenced by patient clinical exam, anatomical trajectory, and the penetrating object's size, shape, and velocity. Methods We present three cases of penetrating traumatic brain injury. Their similarities and differences affecting operative and medical management are compared. We relate our experience with management of penetrating intracranial foreign bodies in general and discuss the relevant literature. Results Our first case was a 12 year old male who presented with a self-inflicted transfacial transcranial injury by a crossbow. The arrow passed through the left sphenoid and cavernous sinus and exited through the parietal calvarium. Our second case was a 37 year old man with a transoral intracranial stab wound by a knife. In our third case, we present a 46 year old male who accidentally fired a nail-gun into his right ear. The nail traversed the posterior wall of the external auditory canal into the posterior fossa, ending in the cerebellar vermis. Each case was treated with craniotomy and foreign body removal. All resulted in good outcomes after surgical treatment. Conclusion Surgery in penetrating traumatic brain injury is the treatment of choice. Our cases demonstrate how certain principles applied to individual patient scenarios may optimize clinical results. Severity of the injury and operative approach are among the most important considerations to achieve the best patient outcomes.