Citation

Kulwin CG, DeNardo A, Khairi S, Payner T. World Neurosurg. 2018; 116: 69-71.

Affiliation

Department of Neurological Surgery, Indiana University School of Medicine and Goodman Campbell Brain and Spine, Indianapolis, Indiana.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.wneu.2018.05.048

PMID

29777884

Abstract

BACKGROUND: While gun-related penetrating traumatic brain injuries make up the majority of cranial missile injuries, low-velocity penetrating injuries present significant clinical difficulties that cannot necessarily be identically managed. Bow hunting is an increasingly popular pastime, and a crossbow allows a unique mechanism to cause a self-inflicted cranial injury with a large, low-velocity projectile. Historically, arrow removal is described in an operating room setting, which provides limited knowledge of the location of vascular injury in the setting of post-removal hemorrhage, and may represent an inefficient use of operating room availability. CASE DESCRIPTION: Two patients presented after self-inflicted cranial crossbow injuries. Both were neurologically salvageable. Initial assessment with CTA allowed triage into likely or unlikely vascular injury. Arrow removal was performed in a radiology setting rather than in the operating room to allow immediate post-removal imaging to localize hemorrhage. While an operating room was on standby, neither patient required neurosurgical operative intervention. Both patients made a good recovery with no further injury caused by arrow removal.

CONCLUSIONS: We describe a novel approach to retained cranial arrow removal in a radiologic, rather than operative setting, and describe its relative benefits over traditional removal in the operating room.

Copyright © 2018 Elsevier Inc. All rights reserved.

Language: en

Keywords

Penetrating brain injury; arrow; bolt; crossbow; self-inflicted; traumatic brain injury