Survival After Massive Penetrating Brain Injury by a Vehicle Roof Rack Bolt: A Case Report and Surgical Challenges

Background: Massive non-missile penetrating brain injury (PBI) caused by large industrial or automotive objects is rare and often associated with high mortality. Management becomes particularly challenging when the foreign body is large enough to prevent standard surgical exposure and produces severe metallic artifacts that preclude reliable preoperative vascular imaging. Case Presentation: A ۲۶-year-old male motorcyclist sustained a right frontal penetrating brain injury caused by a ۱۵-cm-long, ۲-cm-diameter metal bolt from a pickup truck’s roof rack. On arrival, his Glasgow Coma Scale (GCS) score was ۳T (T indicating intubation), and he was hemodynamically stable. Computed tomography (CT) demonstrated transcranial penetration into the right frontal lobe but was severely limited by beam-hardening artifact. Preoperative CT angiography (CTA) was not feasible. Because the size of the impaled object precluded craniotomy prior to removal, emergency extraction was performed along the trajectory, followed immediately by craniotomy, meticulous debridement, duraplasty, and hemostasis. Serial postoperative CTA at ۲۴ hours and ۱ week revealed no vascular injury or traumatic aneurysm. The patient regained full consciousness (GCS ۱۵) within ۷ days and demonstrated no motor deficits. Mild persistent apathy was noted at ۱-month follow-up; however, he had returned to independent daily activities and work. Conclusion: In selected cases of massive non-missile PBI in which standard preoperative craniotomy and CTA are not feasible, immediate extraction followed by prompt decompression and serial vascular imaging may result in favorable neurological outcomes. Early surgical adaptability and close postoperative surveillance are essential.

کلیدواژه ها:

penetrating ، Brain Injuries ، Foreign Bodies ، Craniotomy ، Frontal lobe injuries