PMC3551493_01
Preoperative CT scan: (a) three-dimensional reconstructions highlight the bullet (blue dot) and its trajectory. (b) multiplanar slices confi rmed the proximity of the bullet to the anterior skull base
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F1
Intraoperative images showing the bullet (black asterisk), the olfactory fi bers ( ), the anterior ethmoidal artery (white arrows), the durotomy (dotted line) and the craniectomy (white asterisks). FS: Frontal Sinus, LP: Lamina Papyracea
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F2
The antibiotic therapy (meropenem plus linezolid and fluconazole) was withdrawn and, 1 week later, he underwent endoscopic endonasal removal of the bullet and skull base reconstruction [Figures 2 and 3].
Schematic drawings show the extension of the craniectomy along the coronal plane (a) and the multilayer reconstruction (b) with iliotibial tract (yellow) and the septal fl ap (pink)
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F3
The antibiotic therapy (meropenem plus linezolid and fluconazole) was withdrawn and, 1 week later, he underwent endoscopic endonasal removal of the bullet and skull base reconstruction [Figures 2 and 3].
(a) Postoperative CT scan. (b) Endoscopic examination 1 month after the operation with 0  telescope (left) and 70  telescope (right). White dotted line depicts the right pedicled septal flap. LP: Lamina papyracea, SS: Sphenoid sinus, NP: Nasopharynx, IT: Inferior turbinate, MT: Middle turbinate, ST: Superior turbinate, FS: Frontal sinus
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F4
Early postoperative CT scan ruled out intracranial complications and confirmed proper skull base reconstruction [Figure 4a]. One month postoperative endoscopic control [Figure 4b] and CT imaging after 3 months of follow-up showed no evidence of intracranial complications.