PMC9479510_01
Preoperative picture showing the large metallic hook penetrating the patient's forehead.
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F1
A sort of a medium-sized metallic hook used to fix tents to the ground was penetrating and anchored to the wound and the skull defect [Figure 1].
Oblique plain skull radiograph showing the extension of the metallic object penetration.
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F2
After stabilization in the emergency department, a plain skull radiograph was performed and showed the metallic hook penetrating the frontal bone and extending to the central skull base zone [Figure 2].
3D reconstructed CT scan of the skull showing the midline frontal bone depressed fracture reaching the left orbital roof.
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F3
The midline frontal bone was broken and depressed reaching the left orbital roof [Figure 3].
The metallic tent hook after its removal. It measures about 30 cm in length.
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F4
Therefore, intraoperatively, the scalp wound was extended to perform a craniotomy centered around the hook entry site, exposing the underlying dura which was lacerated at the site of hook penetration, this was followed by cautious retrieval of the hook from within the brain under direct vision where it has been found to have a trajectory from the paramedian right frontal lobe to the contralateral posterior basal left frontal lobe sliding over the medial part of the sphenoid ridge for few millimeters into the anterior left temporal lobe [Figure 4].
Postoperative photo for the patient almost 10 days after surgery while the patient is conscious and oriented.
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F5
Six days after surgery, he has regained his conscious completely to a GCS of 15/15 without any motor or cranial nerve deficits apart from a slight complaint of blurring vision in the left eye [Figure 5].