Management of Non-Missile Penetrating Brain Injuries: A Description of Three Cases and Review of the Literature

Abstract

Nonmissile penetrating intracranial injuries are uncommon events in modern times. Most reported cases describe trajectories through the orbit, skull base foramina, or areas of thin bone such as the temporal squama. Patients who survive such injuries and come to medical attention often require foreign body removal. Critical neurovascular structures are often damaged or at risk of additional injury resulting in further neurological deterioration, life-threatening hemorrhage, or death. Delayed complications can also be significant and include traumatic pseudoaneurysms, arteriovenous fistulas, vasospasm, cerebrospinal fluid leak, and infection. Despite this, given the rarity of these lesions, there is a paucity of literature describing the management of neurovascular injury and skull base repair in this setting. The authors describe three cases of nonmissile penetrating brain injury and review the pertinent literature to describe the management strategies from a contemporary cerebrovascular and skull base surgery perspective.

A Rare Case of Craniocervical Penetrating Injury by a Steel Bar

“…The CT examination and three-dimensional reconstruction helped to understand the relationship between the embedded steel bar and surrounding structures from different perspectives. Patients with penetrating brain injuries have an increased risk of cerebro-vascular injury; the vertebrobasilar artery, internal carotid artery, cavernous sinus, or intracranial great venous sinus may be injured, and the lateral fissures are high-risk areas for the traumatic tract 9 . In this case, the trajectory was a distance away from the important vascular areas.…”

“…6 The general consensus is that the appropriate duration of nasal packing is 3 to 7 days. [7][8][9][10][11] However, some authors have recommended a minimal packing duration (1 day or 6 hours). 12,13 Choi et al 12 analyzed 530 NBF patient with nasal packing and compared among different duration groups.…”

Day 14 intervention for penetrating brain injury with a good Glasgow Coma Scale score: A case report

“…3 Objects that can cause non-missile injuries include knives, pitchforks, crochet hooks, knitting needles, breech pins, umbrellas, crowbars, iron rods, toilet brush handles, chopsticks, flatware, screwdrivers, keys, car antenna aerials, and scissors. 5 These objects have insufficient kinetic energy and velocity to penetrate the cranium. 1,5 Therefore, most reported cases of non-missile injuries involve injuries that have trajectories through the orbit.…”

“…5 These objects have insufficient kinetic energy and velocity to penetrate the cranium. 1,5 Therefore, most reported cases of non-missile injuries involve injuries that have trajectories through the orbit. 6 Immediate (preferably within 12 h) life-saving surgery has been recommended for penetrating brain injury patients.…”

Day 14 Intervention for Penetrating Brain Injury with a Good Glasgow Coma Scale Score: A Case Report

“…Objects that can cause non-missile injuries include knives, pitchforks, crochet hooks, knitting needles, breech pins, umbrellas, crowbars, iron rods, toilet brush handles, chopsticks, flatware, screwdrivers, keys, car antenna aerials, and scissors 5 . These objects have insufficient kinetic energy and velocity to penetrate the cranium 1,5 . Therefore, most reported cases of non-missile injuries involve injuries that have trajectories through the orbit 6 .…”