PMC3589838_01
(a) Photograph of the patient showing the T-shaped metallic spanner penetrating the vault for a left parietal entry point. (b) Skull radiograph demonstrating the T-shaped metallic spanner penetrating the left parieto-occipital lobe of the brain. (c) Intraoperative photograph of craniectomy in preparation for the removal of the retained metal spanner. (d) Postoperative CT scan (Day 3) of the patient showing the craniectomy wound defect along with the hyperdense tract of the removed short arm of metallic spanner. The tract is extending to the contralateral cerebral hemisphere. (e) T-shaped metallic spanner after surgical removal
SNI-4-2-g001.jpg
PMC3589838_01_SNI-4-2-g001.jpg
F1
Necrotic brain tissue was evident at the point of entry of the retained short arm of the spanner [Figure 1a]. T-shaped spanner penetrating the left parieto-occipital lobe of the brain, extending into the contralateral occipital lobe [Figure 1b]. The situation was explained to the attendants and the patient was brought to the operating room with the retained spanner approximately 3 hours after admission and the intervention was designated as high risk. The intracranial part of the metallic spanner was slowly removed followed by debridement and irrigation of the track with normal saline and hydrogen peroxide [Figure 1c-e].