Abdulsada Alkawthar M, Ismail Mustafa, Elsayed Abdelrahman Mohamed, Emara Mohamed R, Al-Khazaali Younus M, Albairmani Sama S, Muthana Ahmed, Hoz Samer S
Department of Neurosurgery, Azerbaijan Medical University, Baku, Azerbaijan.
Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.
Surg Neurol Int. 2023 Feb 24;14:72. doi: 10.25259/SNI_962_2022. eCollection 2023.
Mortality due to head trauma is common in developed countries in all age groups. Nonmissile penetrating skull base injuries (PSBIs) due to foreign bodies are quite rare, accounting for about 0.4%. PSBI carries that a poor prognosis brainstem involvement usually is often fatal. We are reporting the first case of PSBI with a foreign body insertion site through the stephanion with a remarkable outcome.
The 38-year-old male patient was referred with a penetrating stab wound to the head through the stephanion caused by a knife after a conflict in the street. He had no focal neurological deficit or cerebrospinal fluid leak, and Glasgow coma scale (GCS) was 15/15 on admission. A preoperative computed tomography scan showed the path of the stab beginning at the stephanion, which is the point where the coronal suture crosses the superior temporal line, heading toward the cranial base. Postoperatively, GCS was 15/15 without any deficit apart from the left wrist drop, possibly due to a left arm stab.
Careful investigations and diagnoses must be made to ensure convenient knowledge of the case due to the variety of injury mechanisms, foreign body characteristics, and individual patients' characteristics. Reported cases of PSBIs in adults have not reported a stephanion skull base injury. Although brain stem involvement is usually fatal, our patient had a remarkable outcome.
在发达国家，各年龄组因头部创伤导致的死亡率都很常见。因异物造成的非导弹型穿透性颅底损伤（PSBIs）相当罕见，约占0.4%。PSBI伴有脑干受累，预后通常很差，往往是致命的。我们报告首例异物经颞骨颧突插入的PSBI病例，结果显著。
一名38岁男性患者因街头冲突后被刀刺伤头部，经颞骨颧突造成穿透性刺伤前来就诊。他没有局灶性神经功能缺损或脑脊液漏，入院时格拉斯哥昏迷量表（GCS）评分为15/15。术前计算机断层扫描显示刺伤路径始于颞骨颧突，即冠状缝与颞上线交叉处，朝向颅底。术后，GCS评分为15/15，除了可能因左臂刺伤导致的左手腕下垂外，没有任何功能缺损。
由于损伤机制、异物特征和个体患者特征的多样性，必须进行仔细的调查和诊断，以确保全面了解病例情况。已报道的成人PSBI病例中未提及颞骨颧突颅底损伤。虽然脑干受累通常是致命的，但我们的患者结果显著。
