Fujiyama Yuichi, Nomura Sadahiro, Haji Kouhei, Kanaya Hiroko, Fujii Natsumi, Oka Fumiaki, Ishihara Hideyuki
Department of Neurosurgery, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan.
Department of Neurosurgery, Kenwakai Otemachi Hospital, Kokura, Fukuoka, Japan.
NMC Case Rep J. 2024 Oct 11;11:279-283. doi: 10.2176/jns-nmc.2024-0026. eCollection 2024.
The number of penetrating brain injuries (PBI) is low, and the materials of PBI, including bullets, nails, chopsticks, wood, and missiles, vary widely. We report a case in which a nail penetrated the superior sagittal sinus (SSS) and advanced between the cerebral falx but was managed favorably. A 25-year-old male was bruised by a nail gun falling on his head, triggering the ejection of a 3-inch nail into his head. He presented with no symptoms other than mild bleeding and head pain. The patient did not notice the nail injection. Computed tomography (CT) and angiogram revealed that the nail entered parallel to the midline in the interhemispheric fissure through SSS, and there was no intracranial hemorrhage. A bilateral frontoparietal craniotomy was performed with the nail left fixed to the skull. After confirming that the cerebral falx enveloped the entire length of the nail, we extirpated it and sealed the entrance to the SSS. The patient recovered with no neurological deficits, and postoperative images confirmed preservation of the antegrade venous return of the SSS. We observed a case of nail penetration in the SSS. It was essential to perform a thorough imaging examination and the extraction under direct observation using a microscope.
穿透性脑损伤（PBI）的病例数量较少，且PBI的致伤物种类繁多，包括子弹、钉子、筷子、木棍和导弹等。我们报告一例钉子穿透上矢状窦（SSS）并进入大脑镰之间但治疗效果良好的病例。一名25岁男性被落在其头上的射钉枪击伤，致使一枚3英寸长的钉子射入其头部。除了轻度出血和头痛外，他没有其他症状。患者并未注意到钉子射入。计算机断层扫描（CT）和血管造影显示，钉子经SSS在大脑半球间裂内与中线平行进入，且无颅内出血。进行了双侧额顶部开颅手术，钉子仍固定在颅骨上。确认大脑镰包绕钉子全长后，将钉子取出并封闭SSS的入口。患者康复，无神经功能缺损，术后影像证实SSS的顺行静脉回流得以保留。我们观察到一例钉子穿透SSS的病例。进行全面的影像学检查并在显微镜直视下进行取出操作至关重要。
