J Korean Neurosurg Soc.  2014 Dec;56(6):537-539. 10.3340/jkns.2014.56.6.537.

Serious Penetrating Craniocerebral Injury Caused by a Nail Gun

Affiliations
  • 1Department of Anatomy, College of Medicine, Chosun University, Gwangju, Korea.
  • 2Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea.
  • 3Department of Rehabilitation Medicine, Wonju Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 4Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea. chosunns@chosun.ac.kr

Abstract

Penetrating cerebral injuries caused by foreign bodies occur rarely due to the substantial mechanical protection offered by the skull. Throughout most of history, the brain, residing in a "closed box" of bone, has not been vulnerable to external aggression. Recently, we encountered a serious penetrating craniocerebral injury caused by a nail gun. Total excision of the offending nail via emergency craniotomy was performed, but the patient's neurologic status was not improved in spite of aggressive rehabilitative treatment. Here, we report on this troublesome case in light of a review of the relevant literature.

Keyword

Head; Injury; Penetrating

MeSH Terms

Aggression
Brain
Craniocerebral Trauma*
Craniotomy
Emergencies
Foreign Bodies
Head
Skull

Figure

  • Fig. 1 Preoperative simple radiographs show the nail passing through the left parietal calvarium deep to the proximal brainstem.

  • Fig. 2 Preoperative coronal and sagittal computed tomography scans reveal a penetrating metallic nail. Multiple fracture fragments are also observed.

  • Fig. 3 Photograph of the metallic nail after removal.


Reference

1. Bakay L, Glasauer FE, Grand W. Unusual intracranial foreign bodies. Report of five cases. Acta Neurochir (Wien). 1977; 39:219–231. PMID: 602853.
2. Bell RS, Vo AH, Roberts R, Wanebo J, Armonda RA. Wartime traumatic aneurysms : acute presentation, diagnosis, and multimodal treatment of 64 craniocervical arterial injuries. Neurosurgery. 2010; 66:66–79. discussion 79. PMID: 20023539.
3. Gökçek C, Erdem Y, Köktekir E, Karatay M, Bayar MA, Edebali N, et al. Intracranial foreign body. Turk Neurosurg. 2007; 17:121–124. PMID: 17935028.
4. Greene KA, Dickman CA, Smith KA, Kinder EJ, Zabramski JM. Self-inflicted orbital and intracranial injury with a retained foreign body, associated with psychotic depression : case report and review. Surg Neurol. 1993; 40:499–503. PMID: 8235974.
Article
5. Hansen JE, Gudeman SK, Holgate RC, Saunders RA. Penetrating intracranial wood wounds : clinical limitations of computerized tomography. J Neurosurg. 1988; 68:752–756. PMID: 3357035.
Article
6. Kaiser MC, Rodesch G, Capesius P. CT in a case of intracranial penetration of a pencil. A case report. Neuroradiology. 1983; 24:229–231. PMID: 6828239.
Article
7. Kelly AJ, Pople I, Cummins BH. Unusual craniocerebral penetrating injury by a power drill : case report. Surg Neurol. 1992; 38:471–472. PMID: 1298114.
8. Lee JI, Ko JK, Cha SH, Han IH. An unusual case of cerebral penetrating injury by a driven bone fragment secondary to blunt head trauma. J Korean Neurosurg Soc. 2011; 50:532–534. PMID: 22323943.
Article
9. Miller CF, Brodkey JS, Colombi BJ. The danger of intracranial wood. Surg Neurol. 1977; 7:95–103. PMID: 835079.
10. Miner ME, Cabrera JA, Ford E, Ewing-Cobbs L, Amling J. Intracranial penetration due to BB air rifle injuries. Neurosurgery. 1986; 19:952–954. PMID: 3808242.
Article
11. Offiah C, Twigg S. Imaging assessment of penetrating craniocerebral and spinal trauma. Clin Radiol. 2009; 64:1146–1157. PMID: 19913123.
Article
12. Sani S, Jobe KW, Byrne RW. Successful repair of an intracranial nail-gun injury involving the parietal region and the superior sagittal sinus. Case report. J Neurosurg. 2005; 103:567–569. PMID: 16235693.
Article
13. Winder MJ, Monteith SJ, Lightfoot N, Mee E. Penetrating head injury from nailguns : a case series from New Zealand. J Clin Neurosci. 2008; 15:18–25. PMID: 18032048.
14. Yamamoto I, Yamada S, Sato O. Unusual craniocerebral penetrating injury by a chopstick. Surg Neurol. 1985; 23:396–398. PMID: 3975830.
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