Kin Kyohei, Ono Yasuhiro, Fujimori Takeshi, Kuramoto Satoshi, Katsumata Atsushi, Goda Yuji, Kawauchi Masamitsu
Department of Neurosurgery, Kagawa Prefectural Central Hospital.
No Shinkei Geka. 2015 Oct;43(10):921-6. doi: 10.11477/mf.1436203150.
Penetrating brain injury(PBI)is very rare in Japan. Because there is a very wide variety of pathological condition of PBI, the guideline for the treatment of PBI has not been established yet. We report the unique case of PBI caused by a steel wire piece completely embedded in the brain parenchyma. A 75-year-old man was brought to the emergency department due to ocular injury caused by a steel wire piece. Neurological examination revealed only left visual disturbance. CT scan revealed a steel wire piece located intraparenchymally between the left frontal lobe and the ventricles, but digital subtraction angiography showed no significant vascular injury in the surrounding structures. We performed an open surgery and removed the steel wire piece. Because the steel wire piece was completely embedded in the brain, we used intraoperative X-ray fluoroscopy to choose a less invasive approach for the brain. The patient suffered no additional neurological deficit and no sign of cerebral infection or seizure after surgery. He was discharged after a 4-week administration of antibiotics. In most cases of PBI caused by low velocity injury, foreign bodies are not completely embedded in the brain except for remnants after surgical removal. This is the first report of low velocity PBI caused by a foreign body completely embedded in the brain.
穿透性脑损伤（PBI）在日本极为罕见。由于PBI的病理状况多种多样，目前尚未建立PBI的治疗指南。我们报告了一例独特的PBI病例，一枚钢丝碎片完全嵌入脑实质。一名75岁男性因钢丝碎片导致眼部受伤被送至急诊科。神经系统检查仅发现左侧视力障碍。CT扫描显示一枚钢丝碎片位于左额叶和脑室之间的脑实质内，但数字减影血管造影显示周围结构无明显血管损伤。我们进行了开颅手术并取出了钢丝碎片。由于钢丝碎片完全嵌入脑内，我们术中使用X线透视来选择对脑损伤较小的入路。术后患者未出现额外的神经功能缺损，也没有脑感染或癫痫发作的迹象。在给予4周抗生素治疗后他出院了。在大多数由低速损伤导致的PBI病例中，除手术切除后的残留物外，异物不会完全嵌入脑内。这是首次报道由异物完全嵌入脑内导致的低速PBI病例。
