Perioperative Management of Multiple Intracranial Nail Gun Injuries

Abstract

A 51-year-old male presented to the emergency department with four self-inflicted nail gun wounds. Computed tomography angiography demonstrated three nails penetrating the frontal bone toward the falx cerebri causing small subdural hematomas. The fourth nail penetrated the parietal bone posteriorly, ending very close to the vein of Galen. Despite the ominous-appearing imaging, the patient was neurologically intact and cooperative to the point that consideration was given to the possibility of removal of the nails under local anesthesia. Due to the number of nails and proximity of the fourth nail to a major intracranial blood vessel, a general anesthetic was performed observing the usual considerations for a traumatic brain injury. The nails were successfully removed through four small craniotomies and the patient had no complications post-operatively.