title: Nail gun injuries to the head with minimal neurological consequences: a case series.
abstract: BACKGROUND
  An estimated 3700 individuals are seen annually in US emergency departments for nail gun-related injuries. Approximately 45 cases have been reported in the literature concerning nail gun injuries penetrating the cranium. These cases pose a challenge for the neurosurgeon because of the uniqueness of each case, the dynamics of high pressure nail gun injuries, and the surgical planning to remove the foreign body without further vascular injury or uncontrolled intracranial hemorrhage.
  
  
  METHODS
  Here we present four cases of penetrating nail gun injuries with variable presentations. Case 1 is of a 33-year-old white man who sustained 10 nail gunshot injuries to his head. Case 2 is of a 51-year-old white man who sustained bi-temporal nail gun injuries to his head. Cases 3 and 4 are of two white men aged 22 years and 49 years with a single nail gun injury to the head. In the context of these individual cases and a review of similar cases in the literature we present surgical approaches and considerations in the management of nail gun injuries to the cranium. Case 1 presented with cranial nerve deficits, Case 2 required intubation for low Glasgow Coma Scale, while Cases 3 and 4 were neurologically intact on presentation. Three patients underwent angiography for assessment of vascular injury and all patients underwent surgical removal of foreign objects using a vice-grip. No neurological deficits were found in these patients on follow-up.
  
  
  CONCLUSIONS
  Nail gun injuries can present with variable clinical status; mortality and morbidity is low for surgically managed isolated nail gun-related injuries to the head. The current case series describes the surgical use of a vice-grip for a good grip of the nail head and controlled extraction, and these patients appear to have a good postoperative prognosis with minimal neurological deficits postoperatively and on follow-up.
authors.affiliation: Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia. zmakoshi@gmail.com.|Division of Neurosurgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, Canada. zmakoshi@gmail.com.
authors.forename: Ziyad
authors.initials: Z
authors.lastname: Makoshi
authors.affiliation: Division of Neurosurgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, Canada.
authors.forename: Fahad
authors.initials: F
authors.lastname: AlKherayf
authors.affiliation: Division of Neurosurgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, Canada.
authors.forename: Vasco
authors.initials: V
authors.lastname: Da Silva
authors.affiliation: Division of Neurosurgery, Department of Surgery, The Ottawa Hospital - Civic Campus, Ottawa, ON, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Lesiuk
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D003252:Construction Materials / Q000009:adverse effects*; D003257:Consumer Product Safety / Q000331:legislation & jurisprudence*; D005389:Firearms; D005547:Foreign Bodies; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D014481:United States / Q000453:epidemiology; D014754:Violence
keywords: Brain; Nails; Neurosurgery; Penetrating trauma