title: Craniocerebral injury by penetration of a T-shaped metallic spanner: A rare presentation.
abstract: BACKGROUND
  Craniocerebral injuries caused by penetration of metallic foreign bodies present a significant challenge to neurosurgeons as an extensive surgery may be required, leading to high morbidity and mortality.
  
  
  METHODS
  We describe a unique case of penetrating brain injury (PBI) caused by a T-shaped metallic spanner in an assault victim. The patient presented with profuse bleeding from the scalp and necrotic brain tissue evident at the point of entry of the retained short arm of the spanner. Skull X-ray and head computerized tomography (CT) revealed the short arm of spanner penetrating the left parieto-occipital lobe of the brain, extending up to the contralateral occipital lobe. Safe removal of the retained spanner was achieved with a craniectomy and durotomy. Postoperative CT revealed no residual metallic foreign body, and patient had a good functional and neurological outcome at six months' follow up.
  
  
  CONCLUSIONS
  To the best of our knowledge, the successful surgical treatment of a PBI caused by a similar metallic object has not been reported in scientific literature previously. The case is also unique considering the fact that it was managed within the medical and diagnostic constraints of an East African country.
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed Faraz
authors.initials: SF
authors.lastname: Kazim
authors.forename: Atta-Ul-Aleem
authors.initials: AU
authors.lastname: Bhatti
authors.forename: Saniya Siraj
authors.initials: SS
authors.lastname: Godil
keywords: East Africa; metallic foreign body; neurosurgical management; penetrating brain injury