INTRACRANIAL PENETRATING STAB WOUND

Case Report
Aditya Y*, Suhendar A**
* RESIDENCE OF GENERAL SURGERY OF PADJAJARAN UNIVERSITY , ULIN Banjarmasin General Hospital
** CONSULTAN OF NEUROSURGERY OF LAMBUNG MANGKURAT UNIVERSITY , Ulin Banjarmasin General Hospital
INTRODUCTION
Stab wounds to the skull and brain have
become extremely uncommon. Unlike cranio cerebral missile injuries, low velocity penetrating stab wounds damage a focal area
along the tract. Although the nature and shape of offensive instruments are variable, generally over 90 percent of injurie result from
an assault, and knives are the predominant weapon used. The most
appropriate management in the field is to leave the instrument in situ
and carefully transport the patient to a well-equipped trauma center.
We present a patient admitted with a knife embedded in
the skull Penetrating brain injury (PBI) includes all traumatic brain
injuries which are not the result of a blunt mechanism. Although less
prevalent than closed head trauma, PBI carries a worse prognosis.
In civilian populations, PBIs are mostly caused by high velocity objects, which result in more complex injuries and high mortality. PBI
caused by non-missile, low-velocity objects represents a rare pathology among civilians, with better outcome because of more localized
primary injury, and is usually caused by violence, accidents, or even
suicide attempts. Optimum management of PBI requires a good
understanding of the mechanism of injury and its pathophysiology

DISCUSSION
Early recognition and management of stab wounds to the brain is
essential to ensure an optimal outcome. If the weapon has been removed, the
wound can be missed on physical examination The stab wounds are particularly dangerous because of short distance to the brain stem and vascular
structures.

ABSTRACT

27-year-old male was admitted to the

emergency department of ULIN General
Hospital with a knife embedded in the right cheek pointing anterior
and upwards. Neuroimaging showed no vascular impairment. After
obtaining informed consent, the knife was removed. Postoperative
neurological findings showed no deficit. No infection occurred. Brain
stab wounds cause numerous complications, such as intracranial
hemorrhage, injury of important vessels, and infections. Minimal
blade movement during removal and precautions to prevent massive
hemorrhage are essential. Injuries in the maxillofacial and brain stab
wound with knife in situ are not common. We report a rare case with
knife impacted in the, mandible, maxilla and penetrate skull base with
its tip reaching the temporal lobe of the brain .

In this case the knife was in a direction such that no damage to vital
structures occurred. The penetration site, depth of penetration, type of object,
transorbital trajectory, and other factors may be important in determining the
outcome. Brain stab wounds mainly cause intracranial hemorrhage, injury of
important vessels, and infection. Infection frequently results from penetration
of objects through the air sinus or oropharyngeal mucosa, All previous patients could be treated with intravenous antibiotics. However, patients with
septic complications sometimes developed brain abscess.
The cardinal principle is that no attempt should be undertaken to
remove the offending instrument until care full investigation is done, and the
surgeon is prepared to remove the instrument with an appropriate surgical
plan. During operation, care must be taken not to produce any rocking movement which may be transmitted to the tip of the instrument, and removal
should retrace the original trajectory of the weapon. The fundamental principles of surgical management include the prevention of early or late infection,
thorough debridement of necrotic tissue and hematoma, removal of all accessible bone fragments and foreign body and meticulous closure to prevent
cerebrospinal fluid fistula. Blind removal of the penetrating object is dangerous, because blind removal may rock or twist the object, resulting in second-

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