Unusual Self-inflicted Penetrating Brain Injury: A Case Report and Review of Literature

Abstract

Penetrating Brain Injuries (PBIs) usually result in devastating problems and therapeutic challenges. These injuries may occur due to motor vehicle accidents, gunshot wounds or foreign sharp objects such as a knife. Review of related psychiatric articles shows that the patients with mood disorders or psychotic problems may use unusual self-injury methods or tools. Gunshot wounds to the head are common in different countries but there are some case reports explaining unusual suicide attempts such as PBIs caused by sharp objects (e.g. a nail). Surgical approaches of these types of PBIs are controversial and variable based on the literature. In fact, there are different proposed operative techniques including “craniectomy”, “double concentric craniotomy” and “blind extraction”. Each of these methods may have advantages and disadvantages. In this article we present a new method which is named “penisular craniotomy”. This technique can minimize the movement of the sharp objects (e.g. a nail) within the involved critical tissues such as superior sagittal sinus (SSS) or intracerebral parenchyma during extraction. Moreover, because of the maximized visual field, the surgeon can easily control possible intraoperative complications such as bleeding of SSS.