Neurosurgical Management of Self-Inflicted Cranial Crossbow Injury

Kulwin, Charles; DeNardo, Andrew J.; Khairi, Saad; Payner, Troy D.

doi:10.1016/j.wneu.2018.05.048

Cited by 6 publications

(8 citation statements)

References 4 publications

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“…As opposed to other penetrating head injuries with small fragments retained within the tissues, large crossbows need to be removed as soon as possible. [ 15 ] Decompression of neurovascular structures, removal of foreign body and bone fragments, hemostasis, and debridement of the wound with meticulous surgical closure are key goals of the surgery. [ 22 ] Although there is a 10% mortality risk associated with surgical management of these types of injuries, mortality rates increase to 60% if the projectiles are not removed.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic penetrating head injury by crossbow projectiles: A case report and literature review

Khayat,

Alhantoobi

et al. 2024

Surgical Neurology International

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Background: Low-energy penetrating head injuries caused by arrows are relatively uncommon. The objective of this report is to describe a case presentation and management of self-inflicted intracranial injury using a crossbow and to provide a relevant literature review. Case Report: A 31-year-old man with a previous psychiatric history sustained a self-inflicted injury using a crossbow that he bought from a department store. The patient arrived neurologically intact at the hospital, fully awake and oriented. He was not able to verbalize due to immobilization of the jaw as well as fixation of his tongue to his hard palate secondary to the position of the arrow. The trajectory of the object showed an entry point at the floor of the oral cavity and an exit through the calvarium just off the midline. The oral and nasal cavity, along with the palate and, the skull base of the anterior cranial fossa, and the left frontal lobe, were all breached. No vascular injury was identified clinically or in imaging. The arrow was surgically removed in the operating room after establishing an elective surgical airway. The floor of the mouth, tongue, and palate was repaired next. A planned delayed cerebrospinal fluid leak repair was performed. The patient made a substantial recovery and was discharged home in good functional status. A systematic literature search was done using Medline for cases with intracranial injuries related to crossbows to review and appraise the available literature. Conclusion: A thorough assessment in a multidisciplinary trauma center and the availability of a subspecialty care team, including neurosurgery and otolaryngology, are paramount in such cases. The vascular imaging should be done before and after any planned surgical intervention. Emergent and elective surgical airway management should be considered and made available throughout the stabilization and care of the acute injury. Surgical management should be planned to remove the object with adequate exposure to facilitate visualization, removal, and the possible need for further intervention, including anticipating aerodigestive and vascular injuries on removal. Finally, access to weapons and the relation to psychiatric illness should not be overlooked, as many reported cases are self-harming in nature.

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Section: Discussionmentioning

confidence: 99%

“…A total of 24 cases of penetrating head injuries with crossbows have been identified in the literature [ Table 1 ]. [ 1 - 4 , 6 - 15 , 18 - 22 ] The vast majority (20/22) were male, and most of the cases were suicidal (17/24). In addition, 15 cases survived the injury.…”

Section: Case Reportmentioning

confidence: 99%

Traumatic penetrating head injury by crossbow projectiles: A case report and literature review

Khayat,

Alhantoobi

et al. 2024

Surgical Neurology International

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“…In addition, the patient presented with a small skin injury with healthy edges, with no need for wound debridement. Kulwin et al 3 suggest that the removal of arrows and similar low-velocity large penetrating projectiles should occur in a radiologic setting due to increased patient safety and optimized healthcare costs. Nevertheless, the operating room was put on notice for possible emergency surgery in case of severe procedure-related hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…First, most case reports of cranial crossbow and other low-velocity injuries describe removal in the operating room, enabling hemostasis, debridement of necrotic tissues, and closure. 3 Given the long intracranial trajectory of the arrow, and since vascular injury is sometimes only revealed with the removal of the foreign body, we decided to remove retrogradely the arrow in the CT suite, as it would enable the prompt recognition of a possible source of hemorrhage. In addition, the patient presented with a small skin injury with healthy edges, with no need for wound debridement.…”

Section: Palavras-chavementioning

confidence: 99%

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Non-fatal Bihemispheric Penetrating Brain Injury from a Crossbow Arrow with Good Clinical Outcome: Case Report

Januário

Almeida

Calado

et al. 2021

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Crossbow injuries to the head have seldom been reported in the literature, and they represent a unique type of penetrating brain injury (PBI) in which a low-velocity arrow results in an intracranial fragment larger than most high-velocity projectiles, usually with a lethal outcome. We present the case of a 34-year-old man who attempted suicide with a self-inflicted cranial injury from a crossbow arrow, with a right parietal point of entry and a palpable subcutaneous tip in the left parietal region. The emergency team reported a Glasgow coma scale (GCS) score of 15, and the patient was brought sedated and intubated. Computed tomography (CT) imaging scans showed that the arrow crossed both parietal lobes, with mild subarachnoid hemorrhage and small cerebral contusions adjacent to its intracranial path. Careful retrograde removal of the penetrating arrow was performed in the CT suite, followed by an immediate CT scan, which excluded procedure-related complications. The patient woke up easily and was discharged 3 days later with mild left hand apraxia and no other neurologic deficits. To the best of our knowledge, there are no similar case reports describing both good clinical outcome and rapid discharge after a bihemispheric PBI. Individualizing the management of each patient is therefore crucial to achieve the best possible outcome as PBI cases still represent a major challenge to practicing neurosurgeons worldwide.

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Crossbow injuries: A case of suicide

et al. 2022

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Neurosurgical Management of Self-Inflicted Cranial Crossbow Injury

Abstract: We describe a novel approach to retained cranial arrow removal in a radiologic, rather than operative, setting and describe its relative benefits over traditional removal in the operating room.

Cited by 6 publications

References 4 publications

Traumatic penetrating head injury by crossbow projectiles: A case report and literature review

Traumatic penetrating head injury by crossbow projectiles: A case report and literature review

Non-fatal Bihemispheric Penetrating Brain Injury from a Crossbow Arrow with Good Clinical Outcome: Case Report

Crossbow injuries: A case of suicide

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