Childhood penetrating intracranial injury by non-metallic objects: a case report of three pediatric cases.

Background: Despite being relatively rare, pediatric penetrating intracranial injuries entail substantial risks of secondary complications such as intracranial hemorrhage, infection, and mortality.

Case description: This case report describes three pediatric cases of penetrating intracranial injury caused by non-metallic objects, including two bamboo chopsticks and one pencil. In all cases, the patients presented with facial or orbital entry points and underwent prompt clinical evaluation, including computed tomography (CT) scans to assess foreign body location, injury trajectory, and potential complications. Tailored craniotomy approaches were selected based on imaging findings: pterional or subfrontal craniotomies were employed to access and safely extract the foreign bodies. Intraoperatively, great care was taken to avoid further neurological damage, and the dural defects were repaired using grafts and fibrin glue. Postoperatively, all patients received broad-spectrum antibiotics and sodium valproate to prevent infections and seizures, respectively. In two cases, postoperative fever and elevated white blood cell counts suggested intracranial infection, prompting escalation or adjustment of antibiotics, including ceftriaxone and meropenem. No cerebrospinal fluid (CSF) leakage or long-term neurological sequelae were observed. Follow-up evaluations conducted up to three years post-surgery revealed preserved cognitive and sensory functions without signs of epilepsy or delayed complications.

Conclusions: Notably, there were no occurrences of postoperative CSF fistula or epilepsy seizures, and intracranial infections were effectively managed. By documenting these three cases of pediatric intracranial penetrating brain injury, it is evident that accurate diagnosis and immediate surgical intervention are imperative in mitigating secondary brain injury and minimizing the risk of infection or hemorrhage.