PMC3484640_01
Inspection of the head showing only a small open wound with a little swelling.. Note: The foreign body is not visible.
ijgm-5-899f1.jpg
PMC3484640_01_ijgm-5-899f1.jpg
f1-ijgm-5-899
Clinical examination revealed no loss of consciousness, nausea, vomiting, or any other neurological deficit; however, a hard and bloody eschar was noted on his scalp in the occipital region (Figure 1).
CT and CT angiography of the brain. CT of the brain revealing a metallic foreign body penetrating the skull bone (A). In CT angiography (B-D), the superior sagittal sinus (white arrows) as well as the bridging veins (black arrows) seem to be contacted, or even injured by the knife blade.. Abbreviation: CT, computerized tomography.
ijgm-5-899f2.jpg
PMC3484640_01_ijgm-5-899f2.jpg
f2-ijgm-5-899
Additionally, CT angiography demonstrated the foreign body touching, or potentially penetrating, the bridging veins and the superior sagittal sinus (Figure 2), which appeared to be patent.
Intraoperative view. Intraoperative view, demonstrating the knife blade protruding only a few millimeters above the skull surface (A and B), penetrating the skull directly adjacent to the sagittal suture (black arrows), within the elevated bone fragment (B), and after removal (C).
ijgm-5-899f3.jpg
PMC3484640_01_ijgm-5-899f3.jpg
f3-ijgm-5-899
Consequently, we performed a craniotomy that extended beyond the superior sagittal sinus while the knife blade remained in situ (Figure 3).
Postoperative cranial CT angiography and MRI. (A) Postoperative cranial CT angiography revealing a still-open superior sagittal sinus, as well as open bridging veins. (B) MRI of the brain showing that only a slight left parasagittal cortical hemorrhage is present after the trauma and treatment.. Abbreviations: CT, computerized tomography; MRI, magnetic resonance imaging.
ijgm-5-899f4.jpg
PMC3484640_01_ijgm-5-899f4.jpg
f4-ijgm-5-899
The remaining bone fragment was replaced and fixed with titanium clamps (Figure 4). Postoperative neuroimaging revealed only minor intraparenchymal bleeding, but no other morphological changes (Figure 4).