Skip to main content
SpringerLink
Log in

Removal of nail penetrating the basilar artery

  • Case Report
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Nail-gun injuries have become an increasingly prevalent source of penetrating intracranial trauma. Few cases of intracranial nail-gun injuries disturbing major cerebrovascular structures have been reported, and none entailing basilar artery involvement. We report here the case of a 51-year-old male with an intracranial nail-gun injury involving penetration of the distal basilar artery. Operative removal was accomplished under direct vision using a double concentric cranioorbital zygomatic osteotomy for a trans-Sylvian approach. We highlight the principles involved in removing foreign bodies penetrating critical neurovascular structures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. CDC (2007) Nail-gun injuries treated in emergency departments—United States, 2001–2005. Morb Mort Wkly Rep 56:329–332

    Google Scholar 

  2. Day JD, Giannotta SL, Fukushima T (1994) Extradural temporopolar approach to lesions of the upper basilar artery and infrachiasmatic region. J Neurosurg 81:230–235

    Article  CAS  PubMed  Google Scholar 

  3. Kaji T, Yokoyama H, Katayama M, Kusano S, Fujino K, Nakai K, Ishihara S, Umezawa H, Chigasaki H (1996) Penetrating injury of the vertebral artery caused by a nail gun: preoperative embolization. Radiat Med 14:99–101

    CAS  PubMed  Google Scholar 

  4. Ljunggren B, Stromblad LG (1977) The good old method of the nail. Surg Neurol 7:288–292

    CAS  PubMed  Google Scholar 

  5. Ravelli V, Forli C, Parenti G (1987) Unusual penetrating craniocerebral injuries. Report of three cases. J Neurosurg Sci 31:153–156

    CAS  PubMed  Google Scholar 

  6. Sano K (1980) Temporo-polar approach to aneurysms of the basilar artery at and around the distal bifurcation: technical note. Neurol Res 2:361–367

    CAS  PubMed  Google Scholar 

  7. Selvanathan S, Goldschlager T, McMillen J, Campbell S (2007) Penetrating craniocerebral injuries from nail-gun use. J Clin Neurosci 14:678–683

    Article  CAS  PubMed  Google Scholar 

  8. Shenoy SN, Raja A (2003) Unusual self-inflicted penetrating craniocerebral injury by a nail. Neurol India 51:411–413

    CAS  PubMed  Google Scholar 

  9. Spennato P, Bocchetti A, Mirone G, Savarese L, Squillante D, Rotondo M, Natale M (2005) Double concentric craniotomy for a craniocerebral penetrating nail. Case report and technical note. Surg Neurol 64:368–371, discussion 371

    Article  PubMed  Google Scholar 

  10. Springborg JB, Eskesen V, Olsen NV, Gjerris F (2007) Cranio-cerebral injuries caused by nail guns: report on two cases, review of the literature and treatment algorithm. J Trauma 63:E59–E64

    Article  PubMed  Google Scholar 

  11. Tancioni F, Gaetani P, Pugliese R, Rodriguez Y, Baena R (1994) Intracranial nail. A case report. J Neurosurg Sci 38:239–443

    CAS  PubMed  Google Scholar 

  12. Winder MJ, Monteith SJ, Lightfoot N, Mee E (2008) Penetrating head injury from nailguns: a case series from New Zealand. J Clin Neurosci 15:18–25

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Michele Johnson for her input on this case.

Disclaimer

Ketan R. Bulsara report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author information

Authors and Affiliations

  1. Neurovascular Section, Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Dario J. Englot, Maxwell S. Laurans, Khalid Abbed & Ketan R. Bulsara

  2. Department of Neurosurgery, Yale University School of Medicine, P.O. Box 208082, New Haven, CT, 06520, USA

    Ketan R. Bulsara

Authors
  1. Dario J. Englot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxwell S. Laurans
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Khalid Abbed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ketan R. Bulsara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ketan R. Bulsara.

Additional information

Comments

Peter Nakaji, Phoenix, USA

This paper by Englot et al. describes their management of a patient who suffered a nail-gun injury that transited the left temporal lobe and penetrated the basilar artery. Remarkably, the nail produced a nonfatal subarachnoid hemorrhage and occlusion of the basilar artery. Their management consisted of a double concentric craniotomy to leave the nail in place, combined with a trans-Sylvian exposure of the distal basilar artery, both proximally and distally to the nail. This allowed isolation of the opening in the artery and its subsequent primary clipping, with a good neurological outcome.

Nail-gun injuries to the brain are a subset of low-velocity penetrating missile injuries that have more in common with knife wounds, falls onto sharp objects, and spear, arrow, and crossbow bolt injuries than to gunshot wounds. Their low velocity translates into low kinetic energy and a minimal shockwave. Therefore, there is usually little of the peripheral shear damage associated with bullet injuries. The major issue is the location of the nail and the presence or absence of a hematoma. A vascular study is recommended to rule out vascular compromise or injury, such as a traumatic aneurysm. In the absence of vessel injury, it may be reasonable to pull out such an object and obtain a prompt scan. Serial imaging for delayed aneurysm formation may be desirable.

Penetration of a cerebral vessel as occurred in this case is very rare. However, as the authors point out in this paper, there is a high risk of a disaster if it is not managed correctly. They respected the classic principles of vascular neurosurgery: wide exposure and proximal and distal control. The report provides a good illustration of how the application of proper technique can produce a positive outcome in an alarming clinical situation. The authors are to be congratulated on their management.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Englot, D.J., Laurans, M.S., Abbed, K. et al. Removal of nail penetrating the basilar artery. Neurosurg Rev 33, 501–504 (2010). https://doi.org/10.1007/s10143-010-0268-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-010-0268-3

Keywords

Search

Navigation