Dealing with the surgical and medical challenges of penetrating brain injuries

Abstract

Peacetime has reduced the overall incidence of penetrating brain injuries (PBI), and those related to missile penetration are not common anymore at least in western countries. Nevertheless, PBI still occur, and car crashes or work accidents are their main causes. The management of such cases is characterized by many challenges, not only from a surgical and medical point of view, but also for the different and sometimes bizarre dynamics by which they present. Herein we report an unusual deep penetrating brain injury, due to a high-energy crash against a metallic rod in a construction site, with a good surgical outcome despite dramatic clinical conditions on admission. A discussion of the surgical results and functional outcome related to PBI, as found in the English medical literature, is provided. Moreover the most common postoperative complications along with the diagnostic flow charts and therapeutic options useful to prevent inappropriate treatment are highlighted.

Figure 1

Lateral plain X-ray of the skull demonstrates the trajectory of the metallic rod, which enters approximately 1 cm above the supraorbital rim, involves the frontal sinus, and points through the right temporal lobe for an intracranial length of 14.5 cm.

Figure 2

Preoperative axial CT scan of the head shows the entry point of the metallic body, causing radiographical artifacts. The frontal horn damage can be suspected because of the bilateral intraventricular hemorrhage.

Figure 3

Postoperative photograph of the metallic rod, which had a diameter of 6 mm and a length of 35.5 cm.

Figure 4

Postoperative axial CT scan demonstrates residual contusions in the right frontal lobe and in particular the presence of blood in the ventricular system.