Sirko Andrii, Valadka Alex, Armonda Rocco, Dragun Anthony J, Cherednychenko Yurii
Center for Cerebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine.
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J Neurosurg Case Lessons. 2024 Jul 8;8(2). doi: 10.3171/CASE24128.
Transnasal transsphenoidal penetrating craniocerebral injury is very rare even in wartime. Cases with good outcomes are even less common.
A 20-year-old male sustained multiple fragment wounds to his head and face from a landmine explosion. One metal fragment entered his right nostril, traversed the nasal septum and anterior sphenoid sinus, and ricocheted superiorly off the clivus. The fragment then traveled almost to the surface of the left parietal lobe. Subsequently, under its own weight, it migrated back down its original track. The patient suffered cerebrospinal fluid rhinorrhea, pneumocephalus, and right-sided hemiparesis. Digital subtraction angiography was followed by microscopic transnasal skull base reconstruction supplemented by external lumbar drainage. Follow-up brain computed tomogrpahy showed further metallic fragment migration through the ventricular system. The fragment was removed through a transcortical approach. The patient's neurological examination and brain magnetic resonance imaging results demonstrated good recovery.
The absence of external signs of deep injuries does not exclude the presence of a penetrating craniocerebral injury. Metal fragments may undergo ricochet and internal migration in both the brain parenchyma and the ventricular system. Timely diagnosis including three-dimensional reconstruction of a projectile's trajectory may facilitate appropriate surgical planning in complex cases. Intraventricular fragment migration may necessitate microsurgical removal. https://thejns.org/doi/10.3171/CASE24128.
经鼻经蝶穿透性颅脑损伤即使在战时也非常罕见。预后良好的病例更是少见。
一名20岁男性在一次地雷爆炸中头部和面部多处被弹片击中。一块金属碎片进入其右鼻孔，穿过鼻中隔和前蝶窦，然后从斜坡向上反弹。碎片随后几乎到达左顶叶表面。随后，在自身重量作用下，它又沿原路向下移动。患者出现脑脊液鼻漏、气颅和右侧偏瘫。在数字减影血管造影后，进行了显微镜下经鼻颅底重建，并辅以腰大池外引流。随访脑计算机断层扫描显示金属碎片进一步通过脑室系统移动。通过经皮质入路取出了碎片。患者的神经学检查和脑磁共振成像结果显示恢复良好。
深部损伤无外部体征并不排除存在穿透性颅脑损伤。金属碎片可能在脑实质和脑室系统内发生反弹和内部移动。包括对弹丸轨迹进行三维重建在内的及时诊断可能有助于复杂病例的适当手术规划。脑室内碎片移动可能需要显微手术取出。https://thejns.org/doi/10.3171/CASE24128
