[Extensive brain injury caused by attempted suicide with an airgun and ultrasound controlled removal of the deep intracranial projectile].

A 65-year-old man attempted suicide by shooting himself in the right temple with an air-gun. There was no loss of consciousness. He remained neurologically asymptomatic. On plain x-rays, the pellet was found in the left frontal lobe and CT-scans revealed a vast cerebral injury with a large hematoma in the right frontotemporal region and along the bullet track. The entry wound was opened and the hematoma was evacuated after removal of small bone fragments and limited osteoclastic enlargement of the bullet hole under the view of the microscope. No attempt was made to remove the pellet through the bullet track in order to avoid additional injury to delicate frontal midline structures. A left frontal burr hole was made and a thin silastic tube, as used for ventricular drainage, was placed with its tip at the projectile under ultrasonic guidance. Along the tube, the pellet was removed through a 5 mm cortical incision with the use of the microscope. The postoperative course was uneventful, the patient had no neurological deficit and early postoperative CT-scans showed complete removal of the hematoma and the bullet without additional brain injury.