Self-Inflicted Nail Gun Extraction: A Fortunate Case Report
DOI:
https://doi.org/10.24244/dmq44z30Keywords:
NeurosurgeryAbstract
Introduction: The pathophysiological cycle in Chronic Subdural Hematoma (CSDH) involves traumatic and inflammatory components that drive the formation of a membrane with permeable neovascularization. Several studies have concluded that Middle Meningeal Artery embolization (MMAE) can provide a safe and effective minimally invasive alternative treatment. This study was conducted to discuss the MMAE, which may serve as a reference in the management of patients with CSDH. Case: A 71-year-old male patient came to the outpatient clinic, complaining of intermittent headache for the last 2 weeks. The patient has a history of CSDH and had undergone burr-hole drainage. A non-contrast Head CT scan evaluation revealed recurrent CSDH. The patient was then underwent DSA and MMAE procedure using a liquid embolic agent under ETT and TIVA sedation. Result: After the embolization, the MMA was found to be fully occluded. At the end of the procedure, a post-embolization DSA evaluation showed no occlusion in the meningo-ophthalmic anastomosis. One month after the procedure, there wasn’t any neurological deficit and on the Head CT Scan evaluation showed no evidence of CSDH. This procedure already approved by the Ethical Clearence Committee of Ngoerah Hospital. Discussion: MMAE works by inhibiting blood flow through the fragile neovascularized capillaries in the CSDH membrane, thus preventing hematoma growth. MMA embolization carries minimal morbidity and can be performed with local anesthesia or minimal sedation in the majority of cases. This procedure has emerged as a promising, minimally invasive alternative or adjuvant therapy, showing a significantly lower recurrence rate compared to surgery alone. Conclusion: In this study, we performed the MMAE procedure in a case of recurrent CSDH which can be an effective management option. To our study, this is the first case reported in Ngoerah Hospital and this study was made in the hope of serving as a reference for future cases with a larger population.Downloads
References
Van Wyck DW, Grant GA. Penetrating traumatic brain injury: a review of current evaluation and management concepts. J Neurol Neurophysiol. 2015;06(06). doi:10.4172/2155-9562.1000336
Oley MC, Prasetyo E, Tjungkagi F, Manuhutu YN, Sitorus EH. Penetrating Head Injury by a Key: A Case Report. Med Scope J. [Internet]. 2025;7(2):231–5. 7 [cited 2025 Jul 13]. Available from: https://ejournal.unsrat.ac.id/v3/index.php/msj/article/view/59224
Kataria R, Singh D, Chopra S, Sinha V. Low velocity penetrating head injury with impacted foreign bodies in situ. Asian J Neurosurg. 2011;6(01):39–44.
Adji NK, Putri KYW, Nugraha MY, Hamzah SMZ El. Nail penetrating injury to the brain: A case report. Indonesian J Neurosurg. [Internet]. 2022;5(1):10–2. 30 [cited July, 2025]. Available from: https://ina-jns.id/index.php/inajns/article/view/127
Yousefi O, Azami P, Borazjani R, Niakan A, Yadollahi M, Khalili H. Civilian penetrating traumatic brain injury: A 5-year single-center experience. Surg Neurol Int [Internet]. 2023;14:28. [cited 2025 Jul 15]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9990774/
Spanyer JM, Lands HM, Kelly SC, Page PS, Yakkanti MR. Understanding nail gun injuries in orthopedics: Mechanisms and treatment. Orthopedics. 2019;42(5):E410–4. doi:10.3928/01477447-20190812-03
Winder MJ, Monteith SJ, Lightfoot N, Mee E. Penetrating head injury from nailguns: A case series from New Zealand. J Clin Neuroscien. 2008;15(1):18–25. doi:10.1016/j.jocn.2007.06.020
Nail gun safety | Construction | CDC [Internet]. Atlanta (GA): Centers for Disease Control and Prevention; [cited 2025 Jul 14]. Available from: https://www.cdc.gov/niosh/construction/nail-gun-safety/index.html
Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emerg Trauma Shock [Internet]. 2011;4(3):395–402. [cited 2025 Jul 13]. Available from: https://journals.lww.com/onlinejets/fulltext/2011/04030/management_of_penetrating_brain_injury.17.aspx
Buchalter GM, Johnson LP, Reichman M V, Jacobs J. Penetrating trauma to the head and neck from a nail gun: a unique mechanism of injury. Ear Nose Throat J [Internet]. 2002;81(11):779–83. [cited 2025 Jul 13]; Available from: /doi/pdf/10.1177/014556130208101112?download=true
Esposito DP, Walker JB. Contemporary management of penetrating brain injury. Neurosurg Q [Internet]. 2009;19(4):249–54. [cited 2025 Jul 13]. Available from: https://journals.lww.com/neurosurgery-quarterly/fulltext/2009/12000/contemporary_management_of_penetrating_brain.6.aspx
Offiah C, Twigg S. Imaging assessment of penetrating craniocerebral and spinal trauma. Clin Radiolog. 2009;64(12):1146–57. doi:10.1016/j.crad.2009.06.004
Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiolog. Springer New York. 2017;24(3):301–09. doi:10.1007/s10140-016-1477-z
Savitri QM, Putri CP, Gunawan KJ, Hapsari DL, Sidharta I, Wicaksono P. Localized asymptomatic cerebellar abscess after penetrating brain injury by wooden foreign object with adequate antibiotics administration: A case report. Int J Surg Case Rep [Internet]. 2020;72:85-90. [cited 2025 Jul 13]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7289748/
Lan ZG, Richard SA, Li J, Yang C. Nonprojectile penetrating iron rod from the oral cavity to the posterior cranial fossa: A case report and review of literature. Int Med Case Rep J [Internet]. 2018;11:41–5. [cited 2025 Jul 13]. Available from: https://www.tandfonline.com/doi/pdf/10.2147/IMCRJ.S157237
Esposito DP, Walker JB. Contemporary management of penetrating brain injury. Neurosurg Q [Internet]. 2009;19(4):249–54. [cited 2025 Jul 14]. Available from: https://journals.lww.com/neurosurgery-quarterly/fulltext/2009/12000/contemporary_management_of_penetrating_brain.6.aspx
Azman NA, Sze Kiat S. Multiple Nail Gun Penetrating Head Injury: A Case Report. 2013;12(2):75–8.
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