Bui Cuong Xuan, Hoang Anh Huy, Nguyen Bac Nhi, Nguyen Xuan Thanh, Pham Dung Tuan, Dong He Van
Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Vietnam.
Hanoi Medical University, Hanoi, Vietnam.
J Med Case Rep. 2025 Apr 15;19(1):176. doi: 10.1186/s13256-025-05131-3.
Penetrating injuries to the posterior cranial fossa are extremely rare. Perforating skull injuries are also not frequently recorded, with only ten cases reported in the literature. Combining these two factors, this case report presents a patient with a perforating head injury at the posterior cranial fossa caused by an iron rod and shares the clinical management of this rare case.
An 18-year-old Vietnamese male construction worker was admitted following a 3-m fall from scaffolding due to an occupational accident. Upon admission, the patient was conscious, hemodynamically stable, and no neurological deficits or other associated injuries were detected. A 1-m-long, 0.8-cm-diameter iron rod had penetrated from the left neck to the right occipital region. Owing to the size of the foreign body, only an X-ray was performed. The patient underwent emergency surgery to remove the foreign object and manage the damaged brain tissue. Intraoperatively, a contusion of the right cerebellar hemisphere with a complex dural tear, subarachnoid hemorrhage, and multiple small metallic fragments was found, with no spinal cord or major vessel injuries. Postoperatively, the patient recovered well. After 3 years of follow-up, the patient had excellent results and returned to normal daily activities.
The optimal surgical approach should be carefully planned, especially in cases where preoperative computed tomography imaging is challenging. It is recommended to plan the direction of foreign body extraction and limit the use of artificial materials.
颅后窝穿透伤极为罕见。颅骨穿孔伤的记录也不常见，文献中仅报道过10例。综合这两个因素，本病例报告介绍了一名因铁棒导致颅后窝穿孔性头部损伤的患者，并分享了这一罕见病例的临床处理情况。
一名18岁的越南男性建筑工人因职业事故从脚手架上跌落3米后入院。入院时，患者意识清醒，血流动力学稳定，未发现神经功能缺损或其他相关损伤。一根长1米、直径0.8厘米的铁棒从左颈部穿入至右枕部。由于异物尺寸原因，仅进行了X线检查。患者接受了急诊手术以取出异物并处理受损的脑组织。术中发现右小脑半球挫伤，伴有复杂的硬脑膜撕裂、蛛网膜下腔出血和多个小金属碎片，未发现脊髓或大血管损伤。术后，患者恢复良好。经过3年随访，患者效果极佳，恢复了正常日常活动。
应仔细规划最佳手术入路，尤其是在术前计算机断层扫描成像具有挑战性的情况下。建议规划异物取出方向并限制人工材料的使用。
