Transcranial-Penetrating Craniocerebral Injury Inflicted by a Nail Gun: A Technical Case Report

Abstract

This study presents a case of penetrating craniocerebral injury resulting from a nail gun accident, which is a rare etiology for penetrating brain injuries. Immediate surgical intervention is crucial to mitigate the risk of infection. The patient was a 28-year-old male who underwent craniotomy for foreign body extraction and debridement following presentation. Preoperative imaging aided in the precise localization of the injury, and guided the surgical approach. The surgical technique focused on minimizing brain tissue manipulation to prevent further damage. Postoperative care included prophylactic antibiotics and antiseizure medications. No neurological deficits or signs of infection were found on follow-up examination. Nail gun-related injuries are rare; in this case, prompt surgical intervention and meticulous postoperative care contributed to favorable outcomes, emphasizing the importance of timely management in such cases.

Keywords: Injuries; Neurosurgical procedures; Penetrating brain injuries; Wounds.

FIGURE 1. The entry wound in the right temporooccipital area, measuring approximately 0.4 cm in diameter.

FIGURE 2. Supportive examination. (A) The 3-dimensional reconstruction revealing the proximal tip of the nail (black arrow) situated in the inferolateral aspect of the right parietal bone. (B) The brain window of the computed tomography scan shows the distal tip (white arrow) lodged within the right temporal lobe.

FIGURE 3. The step-by-step surgical procedure. (A) The proximal tip of the nail is visible embedded in the parietal bone. (B) The bone flap and nail are simultaneously removed. (C) Durotomy is performed around the nail site, followed by sufficient debridement of the cortex. (D) Duroplasty and (E) cranioplasty are carried out. (F) The dimensions of the nail are measured to be 4.5 cm in length and 0.2 cm in width.

FIGURE 4. The follow-up computed tomography scan shows no remaining nail or bone fragments around the surgical site, as seen in both the axial view (A) brain window and (B) bone window.