Management of Through-and-Through Penetrating Skull Injury: A Railroad Spike That Transgressed the Anterior Skull Base

World Neurosurg. 2018 Feb;110:65-70. doi: 10.1016/j.wneu.2017.09.152. Epub 2017 Oct 13.


Background: Penetrating injuries involving foreign objects that transgress the entirety of the human skull present challenges in the management of vascular injuries, infectious risk, cerebrospinal fluid leak, and cosmetic repair. Ultimately, effective management of these injuries requires a multidisciplinary team and judicious surgical planning.

Case description: Here we present the treatment of a patient who experienced a penetrating injury from a railroad spike, with entry and exit points involving the left and right anterior aspects of the temporal fossa, respectively.

Conclusions: The rationale for management decisions is reviewed in the context of the published literature.

Keywords: Multidisciplinary team; Penetrating skull injury; Traumatic brain injury.

Publication types

  • Case Reports

MeSH terms

  • Angiography, Digital Subtraction
  • Computed Tomography Angiography
  • Head Injuries, Penetrating / complications
  • Head Injuries, Penetrating / diagnostic imaging
  • Head Injuries, Penetrating / pathology*
  • Head Injuries, Penetrating / surgery*
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods*
  • Skull Base / diagnostic imaging
  • Skull Base / injuries*
  • Tomography Scanners, X-Ray Computed