Transcranial Stab Wounds: A Report of Three Cases and Suggestions for Management

Abstract

Transcranial stab wounds are uncommon. Three such cases are presented. The severity of the wounds may vary from innocuous to devastating. Skull films are useful in delineating the depth of penetration. The presence of the knife blade in situ may make the computed tomographic scan impossible to perform or difficult to interpret. Cerebral angiography may be indicated if injury to a major cerebral vessel is suspected or if the patient suffers a delayed subarachnoid or intracerebral hemorrhage. Provided that the patient's clinical status indicates a positive prognosis, transcranial stab wounds should be explored surgically. The weapon should be removed in the operating room immediately before or at the time of operation.

Three years with a knife stuck in the brain

“…1,6 When the blade remains retained, it is necessary to remove it, and to do so, the approach must be carefully planned, due to the risk of recurrent bleeding in areas that were tamponade and additional injuries due to mobilization of the blade. 1,7 When a long-term permanence in nervous tissue occurs, it is expected that the reaction to the presence of the foreign body causes adhesion, as occurred in the case presented; it makes removal more difficult, requiring meticulous dissection to separate the blade from the surrounding tissue. Plain radiograph allows to assess the dimensions and location of the foreign body; computed tomographic scan, besides providing additional information regarding the size and path of the blade, allows the diagnosis of hematoma or abscess.…”

“…It is also important to perform an arteriography to check for large vessels nearby and to discard the existence of aneurysms or traumatic arteriovenous fistulas. 1,7 As usual, the craniotomy was performed with the object at its center, being small so that the flap does not obstruct the line of sight of the surgeon; to facilitate access to the affected area, a strip of bone was extracted from the skull, broadening the exposed region of the cerebrum. Blade movement can occur during craniotomy, especially at the end of procedure; 8 fixation with metal plates minimized this risk.…”

“…During removal, gentle traction is useful; however, it should be strictly held along the axis of blade. 1 To prevent unwanted movements, it was crucial to have good support for the surgeon assistant firmly hold the bone flap assembly with the blade, this was obtained by means of the Caspar retractor pins. As there was no evidence of infection, it was decided to perform cranioplasty immediately.…”

“…The low speed of the object to cross the nervous tissue explains why the lesion typically is restricted to the path of the blade and, therefore, when there is no injury of large vessels or involvement of vital areas such as the brainstem, the patient often gets conscious and with good chances of recovery. [1][2][3] It is assumed that such patients have a higher incidence of complications when the blade is retained inside the skull, as there may be recurrence of bleeding in areas that were tamponade or adding of nervous injuries caused by movements of the blade during removal. 4 When the blade remains for a long period, it is expected that the risk increases as the erosion makes the metal surface less smooth and there is possibility of adherence to adjacent tissue.…”

Unusual cranial trauma caused by pencil in teenager: case report

“…If a major vascular lesion is suspected in the venous sinus and in cases of late subarachnoid hemorrhage or intracerebral hemorrhage, angiography by digital brain subtraction may be indicated after intervention for surgical planning (6,7,9,10,13). If the first scan is negative, it is best to repeat the examination 2 to 3 weeks later (14).…”