Unusual Self-inflicted Penetrating Brain Injury: A Case Report and Review of Literature

Javad Aghazade, Firooz Salehpoor, Nader Nader, Atta Mahdkhah, Amir Rezakhah, Farhad Mirzaee


Penetrating Brain Injuries (PBIs) usually result in devastating problems and therapeutic challenges. These injuries may occur due to motor vehicle accidents, gunshot wounds or foreign sharp objects such as a knife. Review of related psychiatric articles shows that the patients with mood disorders or psychotic problems may use unusual self-injury methods or tools. Gunshot wounds to the head are common in different countries but there are some case reports explaining unusual suicide attempts such as PBIs caused by sharp objects (e.g. a nail). Surgical approaches of these types of PBIs are controversial and variable based on the literature. In fact, there are different proposed operative techniques including “craniectomy”, “double concentric craniotomy” and “blind extraction”. Each of these methods may have advantages and disadvantages.

In this article we present a new method which is named “penisular craniotomy”. This technique can minimize the movement of the sharp objects (e.g. a nail) within the involved critical tissues such as superior sagittal sinus (SSS) or intracerebral parenchyma during extraction. Moreover, because of the maximized visual field, the surgeon can easily control possible intraoperative complications such as bleeding of SSS.

Full Text:



Bell RS, Mossop CM, Dirks MS, Stephens FL, Mulligan L, Ecker R, Neal CJ, Kumar A, Tigno T, Armonda RA. Early decompressive craniectomy for severe penetrating and closed head injury during wartime. Neurosurg Focus. 2010;28(5):E1.

Ecker RD, Mulligan LP, Dirks M, Bell RS, Severson MA, Howard RS, Armonda RA. Outcomes of 33 patients from the wars in Iraq and Afghanistan undergoing bilateral or bicompartmental craniectomy. J Neurosurg. 2011 ;115(1):124-9.

Klimo P Jr1, Ragel BT, Rosner M, Gluf W, McCafferty R. Can surgery improve neurological function in penetrating spinal injury? A review of the military and civilian literature and treatment recommendations for military neurosurgeons.Neurosurg Focus. 2010 ;28(5):E4.

Rashim Kataria, Deepak Singh, Sanjeev Chopra, V.D.Sinha. Low velocity penetrating head injury with impacted foreign bodies in situ. Asian Journal of Neurosurgery. 2011; 6(11):10-11.

Alexander A Grunsfeld and Ivan S Login. Abulia following traumatic brain injury during endoscopic sinus surgery with disruption of anterior cingulate circuit: case report . BMC Neurology . 2006; 6(4):34-36.

Abarca-Olivas, J.; Concepcion-Aramendia, L. A.; Baro-Ruiz, E.; Caminero-Canas, M. A.; Navarro-Moncho, J. A.; Botella-Asuncion, C. Perforating brain injury from a speargun. A case report. Revista Neurocirugia. 2011; 22(3):271-272.

Mark J Winder, Stephen J Monteith, Nicholas Lightfoot, Edward Mee. Penetrating head injury from nailguns: a case series from New Zealand. Journal of Clinical Neuroscience 2008; 15(1):18-25.

Zachary N. Litvack, Matthew A. Hunt, Jason S. Weinstein and G. Alexander West. Self-inflicted nail-gun injury with 12 cranial penetrations and associated cerebral trauma Case report and review of the literature. Journal of Neurosurgery. 2006; 104(5): 828-834.

Matthias Frank, Rico Grossjohann, Wolfgang Schikorr, Ralf Tesch, Jörn Lange, Axel Ekkernkamp, Sönke Langner, Britta Bockholdt, Frank Tost. Nail projectiles propelled by a mason’s lacing cord: an experimental approach. International Journal of Legal Medicine.2013; 127(1):153-158.

Wei Luo, Hai Liu, Shuyu Hao, Ying Zhang, Jingsheng Li, Baiyun Liu. Penetrating brain injury caused by nail guns: Two case reports and a review of the literature. Brain Injury .2012;26(13-14): 1756-1762.

Cara L. Sedney, Todd Harshbarger, John Orphanos, John J. Collins. Penetrating Injury to the Superior Sagittal Sinus by a Nail in a 4-Year-Old Child. Pediatric Emergency Care.2012; 28(11): 1220-1223.

Michael Neil Woodall, Cargill H. Alleyne. Nail-gun head trauma. Journal of Trauma and Acute Care Surgery .2012;73(4): 993-996.

Pei Chen, YingChun Zhou, NanXiang Xiong, Lei Yang, LiXin Zhu. Penetrating Cranionasal Injury in a Child Caused by a Bicycle Spoke. Pediatric Emergency Care.2012; 26(11): 837-839.

Mark J. Winder, Steven J. Monteith, Graeme Macdonald. Nailed: The Case of 24 Self-Inflicted Intracranial Nails From a Pneumatic Nailgun. The Journal of Trauma: Injury, Infection, and Critical Care .2010; 68(4): E104-E107.

Caponetti Rosita, Gravante Gianpiero, Caponetti Tania, Aloisio Patrizio, Fierro Aldo. Images of Trauma: Multiple Self-Inflicted Injuries in an Incarcerated Man. The Journal of Trauma: Injury, Infection, and Critical Care.2009; 66(6): 1744.

Tetsuya HIRAISHI, Tadashi KAWAGUCHI, Tsutomu KOBAYASHI, Masaru TOMIKAWA, Yasushi ITO, Yukihiko FUJII. Unstable Stenosis of the Internal Carotid Artery Caused by a Craniofacial Nail-Gun Injury. Neurologia medico-chirurgica . 2009; 49(12): 590-593.

Daniel Jenkins, Andreia Marques-Baptista, Mark A. Merlin. Injury by Power Tool. JEMS: Journal of Emergency Medical Services . 2008; 33(11): 38-40.

Raquel Gutiérrez-González, Gregorio R. Boto, Mónica Rivero-Garvía, Álvaro Pérez-Zamarrón, Gustavo Gómez. Penetrating brain injury by drill bit. Clinical Neurology and Neurosurgery.2008; 110(2): 207-210.

M Winder, S Monteith, N Lightfoot, E Mee. Penetrating head injury from nailguns: A case series from New Zealand. Journal of Clinical Neuroscience.2008; 15(1): 18-25.

A Nitsch, R Verheggen, H Merten. Penetrating pneumatic nail-gun injury to skull base. British Journal of Oral and Maxillofacial Surgery.2007; 45(8): 692-692.

Ryan J. Pauls, Bill Y. Ong, W. Alan C. Mutch, Joseph A. Silvaggio. Anesthetic management for a nailgun injury involving a cerebral venous sinus. Canadian Journal of Anesthesia/Journal canadien d'anesthésie.2007; 54(11):954-955.

George M. Testerman, Laura M. Dacks. Multiple Self-inflicted Nail Gun Head Injury. Southern Medical Journal.2007; 100(6): 608-610.

Alice D. Lee, Young S. Oh.Unusual Delayed Presentation of a Nail Gun Injury Through the Skull Base. The Laryngoscope. 2007;117(6): 977-980.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

Advances in Bioscience and Clinical Medicine