PMC5849932_01
Preoperative images (A-D) showing the iron rod both in the patient and on imaging studies. (E and F) are postoperative CT scan images.. Note: Modified with permission from Huang J, Li D, Chen H. Successful management of a penetrating ironrod injury through the oral cavity involving the posterior cranial fossa. Neurol India. 2017;65(3):666-668.. Abbreviation: CT, computed tomography.
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On arrival at our department, he was alert and cooperative (Glasgow coma scale (GCS) score 15) (Figure 1A). Skull radiographs showed that a solid metallic bar, 30 cm long, had penetrated through the right anguli oris eminence and was lodged low in the right occipital bone (Figure 1B and C). The extent of structural damage could not be ascertained on the computed tomography (CT) scans as a consequence of severe artifacts associated with the metal bar (Figure 1D). Postoperative CT scan revealed no hematoma of edema (Figure 1E and F).
Digital subtraction angiography images showing the iron rod penetrating the bones but narrowly missing the right internal carotid artery (A-D).. Note: Modified with permission from Huang J, Li D, Chen H. Successful management of a penetrating ironrod injury through the oral cavity involving the posterior cranial fossa. Neurol India. 2017;65(3):666-668.
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CT angiography (CTA) illustrated that the metal rod steered clear of the internal carotid artery and narrowly missed the vertebral artery (Figure 2A-D).
Intraoperative images showing the iron rod lodged in the posterior skull and in the brain tissues (A-D).. Note: Modified with permission from Huang J, Li D, Chen H. Successful management of a penetrating ironrod injury through the oral cavity involving the posterior cranial fossa. Neurol India. 2017;65(3):666-668.
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The patient was placed in a park-bench position (Figure 3A). After clearance of the musculature, the rod was visualized penetrating through the occipital squama (Figure 3B). The metal rod was further exposed to be going through the dura but left the brain stem alone (Figure 3C). The ipsilateral vertebral artery was revealed to be intact (Figure 3D).
MRI taken during follow-up outpatient visit 3 months after the removal of the iron rod (A and B).
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MRI at the 3-month follow-up showed no abscess formation (Figure 4A and B).