title: Treatment of Penetrating Nonmissile Traumatic Brain Injury. Case Series and Review of the Literature.
abstract: BACKGROUND
  Penetrating traumatic brain injuries (TBIs), with the exception of gunshot wounds, are relatively rare occurrences and affect all ages. Clinical presentation varies depending on the mechanism of the injury. Prompt surgical treatment is often indicated and is influenced by patient clinical examination, anatomic trajectory, and the penetrating object's size, shape, and velocity.
  
  
  METHODS
  We present 3 cases of penetrating TBI. Their similarities and differences affecting operative and medical management are compared. We relate our experience with management of penetrating intracranial foreign bodies in general and discuss the relevant literature.
  
  
  RESULTS
  Our first case was a 12-year-old male who presented with a self-inflicted transfacial transcranial injury by a crossbow. The arrow passed through the left sphenoid and cavernous sinus and exited through the parietal calvarium. Our second case was a 37-year-old man with a transoral intracranial stab wound by a knife. In our third case, we present a 46-year-old male who accidentally fired a nail gun into his right ear. The nail traversed the posterior wall of the external auditory canal into the posterior fossa, ending in the cerebellar vermis. Each case was treated with craniotomy and foreign body removal. All resulted in good outcomes after surgical treatment.
  
  
  CONCLUSIONS
  Surgery in penetrating TBI is the treatment of choice. Our cases demonstrate how certain principles applied to individual patient scenarios may optimize clinical results. Severity of the injury and operative approach are among the most important considerations to achieve the best patient outcomes.
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA. Electronic address: zycks@upstate.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Zyck
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors.forename: Gentian
authors.initials: G
authors.lastname: Toshkezi
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors.forename: Satish
authors.initials: S
authors.lastname: Krishnamurthy
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Carter
authors.affiliation: Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Siddiqui
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Hazama
authors.affiliation: Department of Neurosurgery, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Mayur
authors.initials: M
authors.lastname: Jayarao
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Chin
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001921:Brain / Q000601:surgery; D000070642:Brain Injuries, Traumatic / Q000601:surgery*; D002648:Child; D000072226:Computed Tomography Angiography; D003399:Craniotomy / Q000379:methods; D005547:Foreign Bodies / Q000601:surgery; D020197:Head Injuries, Penetrating / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014951:Wounds, Stab / Q000601:surgery*
keywords: Foreign body; Intracranial; Neurotrauma; Penetrating brain injury; Traumatic brain injury