症例報告
自動釘打機による穿通性脳損傷の１例
2025 年 48 巻 1 号 p. 1-4
詳細
2025 年 48 巻 1 号 p. 1-4
Penetrating brain injuries are rare in head trauma, but nerve damage, vascular injury, and infections must be considered de pending on the type and trajectory of penetration. We report a case of a penetrating brain injury caused by an automatic nail gun.
A 59–year–old man attempted suicide by driving a nail into his right temporal region with an automatic nail gun. Upon admission, the patient was conscious but exhibited mild paralysis in the left upper and lower limbs. A head CT scan showed that the nail had penetrated the right temporal bone and reached the right frontal lobe, with no significant bleeding around the nail. A head CT angiography confirmed no contact with major arteries, indicating that nail removal was feasible.
On the day of admission, the removal of the intracranial foreign body was performed under general anesthesia. A 6 cm linear skin incision was made around the nail, and a diameter of 3 cm area of bone surrounding the nail was exposed. Two burr holes created two bone fragments: one fragment enclosing the nail and another larger fragment around the first. The outer bone fragment was carefully removed to avoid displacing the nail embedded in the dura. The inner fragment containing the nail was cautiously extracted, minimizing the force transmitted to the subdural space. There was no cerebrospinal fluid leakage or active bleeding at the removal site, and intraoperative CT confirmed no worsening of intracranial hemorrhage. Postoperatively, the patient experienced no deterioration in consciousness or motor function. Follow–up CT revealed minor bleeding near the nail tip, which did not progress. Sulbactam sodium and ampicillin sodium were administered postoperatively, with no signs of intracranial infection observed. The patient was transferred for rehabilitation.
While nail–induced penetrating brain injuries are rare, careful planning of the removal method and management of postoperative complications is crucial. In this case, creating two bone fragments —one enclosing the nail and another larger fragment surrounding the first— proved effective and safe.
