Penetrating intracranial injury through temporal bone with a retained stab: A case report and literature review

Background

An instrument that penetrates the dura mater and the thickness of the skull bone is considered to have produced a penetrating craniocerebral injury. Nonmissile penetrants and missiles are two types of penetrating agents. Nonmissile penetrants can travel at low speeds or at high speeds (>100 m/s). It might stay inside the skull or come out of another place. One item that can inflict piercing injuries on civilians is a knife. Although the precise frequency of penetrating head injuries in the general population is unknown, current estimates suggest that bullets account for 4.6 % of these injuries, while puncture wounds from stabs, nails, and other trauma account for 0.4 %. Unlike European reports, Reportedly, male assailants in South Africa are much more likely to have suffered a single head-stab wound. The frontal bone is the most frontal, thickest, and most accessible section of the skull for assailants; nevertheless, the orbit and squamous portion of the temporal bone are thinner, more fragile, and more appealing to skilled attackers.

Case presentation

This is a 29-year-old male patient referred to our hospital after being referred from the primary hospital. He sustained a stab injury to the left temporal area of the head, bleeding from the scalp, and loss of consciousness. The stab is retained in the brain, with its tip visible in the left temporal area (Fig. 1). GCS is 10/15; the pupils are midsized and non-reactive bilaterally, and he had a left-side preference. On a brain CT scan, there is a left temporal area foreign body seen penetrating through the scalp, skull temporal bone, temporal lobe, and occipital lobe of the brain with a stab tip at the edge of the left tentorium cerebelli, and there is an associated left massive acute subdural hematoma and intraventricular hemorrhage extending from the lateral ventricle to the fourth ventricle (Fig. 2). We did left-side decompressive craniectomy, expansile duraplasty, and removed a foreign body (stab) safely (Fig. 3), and postoperatively, the patient was discharged with stable vital signs and no neurologic deficit with improved GCS 15/15.

Conclusion

The main idea is to wait to remove the knife until after a thorough investigation has been completed and the interdisciplinary team is ready to remove the instrument using suitable techniques. Removing the penetrating object should allow the knife to follow its original path. It’s important to avoid making any rocking motions during the extraction process that could endanger vital neurovascular structures at risk at the knife's tip.