Foreign body of the brainstem by penetrating injury: Conservative treatment

Abstract

Traumatic brainstem injuries usually lead to severe lesions and unfavourable outcome. In the literature, the few cases with favourable outcome all benefited from surgical removal of the foreign body. We report a very unusual case of a penetrating brainstem injury with a crossbow arrow with conservative treatment and favourable clinical course despite an infectious complication (brainstem abscess). This case illustrates an important gap between a good clinical status and the severity of the lesion highlighted by CT scan. In addition, a collegial decision was made not to treat the lesion surgically, but only the complication, the abscess, by stereotactic puncture. The treatment must thus be tailored in this type of lesion.