Late Removal of Brain-Penetrating Nails Adherent to Intracranial Arteries: A Case Report
Qian, Cheng; Isokangas, Juha-Matti; Lahtinen, Maija; Suutari, Angelica; von und zu Fraunberg, Mikael; Knuutinen, Oula (2023-10-17)
Lippincott Williams & Wilkins
17.10.2023
Qian, C., Isokangas, J.-M., Lahtinen, M., Suutari, A., Von Und Zu Fraunberg, M., & Knuutinen, O. (2023). Late removal of brain-penetrating nails adherent to intracranial arteries: A case report. Neurosurgery Practice, 4(4):e00068, December 2023. https://doi.org/10.1227/neuprac.0000000000000068.
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© The Author(s) 2023. Published by Wolters Kluwer Health, Inc. on behalf of Congress of Neurological Surgeons. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
© The Author(s) 2023. Published by Wolters Kluwer Health, Inc. on behalf of Congress of Neurological Surgeons. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
https://creativecommons.org/licenses/by/4.0/
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https://urn.fi/URN:NBN:fi:oulu-202411266922
https://urn.fi/URN:NBN:fi:oulu-202411266922
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Abstract
Background and importance:
Pneumatic nail guns are a rare cause of penetrating brain injury, and subsequent nail removal in the acute setting is well reported. However, reports of late removal or removal of nails adjacent to intracranial vessels are rare. In the delayed setting, scar formation around the nails and surrounding brain structures may complicate surgical removal. Here, we report a case of late removal of brain-penetrating nails adherent to the middle cerebral artery branches.
Clinical presentation:
A 70-year-old left-handed male presented with mild aphasia, vertigo, and facial nerve palsy. Imaging studies demonstrated two nails fired 2 months before in the right temporal lobe adjacent to the middle cerebral artery branches. The nails were surgically removed through a modified pterional approach after meticulous dissection of scar tissue adherent to the nails. Before removal, proximal vessel control was achieved.
Conclusion:
Brain-penetrating nail removal weeks after the original incident may be complicated by extensive scarring. This can be dealt with a generous craniotomy, proximal vessel control through microsurgical or endovascular means, and careful dissection of scar tissue around the nails.
Background and importance:
Pneumatic nail guns are a rare cause of penetrating brain injury, and subsequent nail removal in the acute setting is well reported. However, reports of late removal or removal of nails adjacent to intracranial vessels are rare. In the delayed setting, scar formation around the nails and surrounding brain structures may complicate surgical removal. Here, we report a case of late removal of brain-penetrating nails adherent to the middle cerebral artery branches.
Clinical presentation:
A 70-year-old left-handed male presented with mild aphasia, vertigo, and facial nerve palsy. Imaging studies demonstrated two nails fired 2 months before in the right temporal lobe adjacent to the middle cerebral artery branches. The nails were surgically removed through a modified pterional approach after meticulous dissection of scar tissue adherent to the nails. Before removal, proximal vessel control was achieved.
Conclusion:
Brain-penetrating nail removal weeks after the original incident may be complicated by extensive scarring. This can be dealt with a generous craniotomy, proximal vessel control through microsurgical or endovascular means, and careful dissection of scar tissue around the nails.
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