Treatment of a self-inflicted intracranial nail gun injury

Abstract

A 30-year-old man walked into the emergency department after a suicide attempt by firing a nail from a pneumatic nail gun directed at his left temple. He was haemodynamically stable and neurologically intact, able to recall all events and moving all extremities with a Glascow Coma Scale of 15. CT of the brain showed a 6.3 cm nail in the right frontal region without major intracerebral vessel disruption. He was taken to the operating room for left temporal wound washout, debridement of gross contamination and closure with titanium cranial fixation plate. The foreign body was not accessible on initial surgical intervention and was left in place to define anatomy and plan for subsequent removal. Thin slice CT images were used to create 3D reconstructions to facilitate stereotactic navigation and foreign body removal via right craniotomy the following day. The patient tolerated the procedures well and recovered with full neurological function.

Surgical management of a penetrating drill bit injury to the skull base

“…Neuronavigation can further help localize the object intraoperatively. [ 12 ] Neurosurgical removal remains the primary treatment modality. [ 5 , 8 ] Yet, it carries risk of intracranial hemorrhages.…”

“…Other groups reported the use of preoperative piperacillin/tazobactam and postoperative vancomycin combined with meropenem. [ 12 ] Further, a comprehensive psychiatric assessment should be considered in case of posttraumatic acute stress disorder or adaptive disorder.…”

“…e literature suggests that neurosurgical removal under direct vision remains the safest treatment strategy. [6,12] the emergency department following an assault resulting in an orbital injury and loss of consciousness for 20 min. He had orbital apex syndrome with left-sided amaurosis, ophthalmoplegia, ptosis, and trigeminal hypoesthesia of branches V1 and V2.…”

“…The literature suggests that neurosurgical removal under direct vision remains the safest treatment strategy. [ 6 , 12 ]…”

Thirty-two nails injected into the head: An operative report and review of the literature

“…[ 13 ] Important risk factors for poor clinical outcomes include major vascular injury in the brain, pseudoaneurysms, and injury to the brainstem. [ 7 , 9 , 15 ] Therefore, it is important to use preoperative and postoperative CT or conventional angiography to assess extent of vascular involvement. [ 9 ] In addition, stereotactic navigation, intraoperative ultrasound, and intraoperative fluoroscopy ensure complete removal of the foreign bodies to prevent future brain abscess formation.…”