{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T20:01:11Z","timestamp":1771272071539,"version":"3.50.1"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Extraction of a bullet fragment seated in deep brain parenchyma utilizing a neuroendoscope has not been previously reported in the literature. The authors report the case of a 4-year-old patient who presented after a pellet gun injury with a projectile located 6 cm intracranially and lodged within the posterior thalamus and near the posterior limb of the internal capsule. Initial operative repair included repair of a CSF leak with duraplasty, minimal brain debridement, and elevation of a depressed skull fracture. Subsequent CT at 2 months postoperatively revealed migration of the deep intracranial pellet. This finding correlated with intermittent worsening neurological symptoms and signs. A rigid 3-mm neuroendoscope with CT stereotactic navigation was then used to remove the pellet fragment from the thalamus. The patient returned home with alleviation of clinical symptoms and an uneventful postoperative recovery. This case demonstrates that navigation-guided neuroendoscopy can be successfully used to remove projectile fragments from deep brain structures, especially when the migration is along the initial path of the bullet. This technique represents another low-risk curative option in the management of retained bullet fragments in gunshot wound injuries to the head.<\/jats:p>","DOI":"10.3171\/2020.4.peds19606","type":"journal-article","created":{"date-parts":[[2020,7,10]],"date-time":"2020-07-10T07:06:58Z","timestamp":1594364818000},"page":"445-448","source":"Crossref","is-referenced-by-count":4,"title":["Navigation-guided neuroendoscopic removal of an intracranial migratory pellet from the thalamus of a 4-year-old girl"],"prefix":"10.3171","volume":"26","author":[{"given":"Pate J.","family":"Duddleston","sequence":"first","affiliation":[{"name":"School of Medicine, Mercer University, Macon; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian L.","family":"Gendreau","sequence":"additional","affiliation":[{"name":"School of Medicine, Mercer University, Macon; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen A.","family":"Little","sequence":"additional","affiliation":[{"name":"Neurological and Spine Institute of Savannah, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Andrews","sequence":"additional","affiliation":[{"name":"Neurological and Spine Institute of Savannah, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willard D.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Neurological and Spine Institute of Savannah, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1097\/00005373-199610000-00013","article-title":"Air-powered guns: too much firepower to be a toy","volume":"41","author":"Bond SJ","year":"1996","unstructured":"Bond SJ, Schnier GC, Miller FB. Air-powered guns: too much firepower to be a toy. J Trauma. 1996;41(4):674\u2013678.885802710.1097\/00005373-199610000-00013"},{"issue":"2","key":"b2","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"215","DOI":"10.3171\/2015.6.PEDS15148","article-title":"Penetrating head injuries in children due to BB and pellet guns: a poorly recognized public health risk","volume":"17","author":"Kumar R","year":"2016","unstructured":"Kumar R, Kumar R, Mallory GW,  Penetrating head injuries in children due to BB and pellet guns: a poorly recognized public health risk. J Neurosurg Pediatr. 2016;17(2):215\u2013221.2649663310.3171\/2015.6.PEDS15148"},{"issue":"4","key":"b3","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1542\/peds.100.4.609","article-title":"Serious and fatal air gun injuries: more than meets the eye","volume":"100","author":"Bratton SL","year":"1997","unstructured":"Bratton SL, Dowd MD, Brogan TV, Hegenbarth MA. Serious and fatal air gun injuries: more than meets the eye. Pediatrics. 1997;100(4):609\u2013612.10.1542\/peds.100.4.6099310513"},{"issue":"4","key":"b4","series-title":"J Biomech Eng","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1115\/1.1287160","article-title":"Infant skull and suture properties: measurements and implications for mechanisms of pediatric brain injury","volume":"122","author":"Margulies SS","year":"2000","unstructured":"Margulies SS, Thibault KL. Infant skull and suture properties: measurements and implications for mechanisms of pediatric brain injury. J Biomech Eng. 2000;122(4):364\u2013371.1103655910.1115\/1.1287160"},{"issue":"3","key":"b5","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1159\/000085873","article-title":"Spontaneous movement of bullets in the interhemispheric region","volume":"41","author":"Karabagli H","year":"2005","unstructured":"Karabagli H. Spontaneous movement of bullets in the interhemispheric region. Pediatr Neurosurg. 2005;41(3):148\u2013150.1599533310.1159\/000085873"},{"issue":"3","key":"b6","series-title":"Inj Prev","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1136\/ip.8.3.185","article-title":"Trends in BB\/pellet gun injuries in children and teenagers in the United States, 1985-99","volume":"8","author":"Nguyen MH","year":"2002","unstructured":"Nguyen MH, Annest JL, Mercy JA,  Trends in BB\/pellet gun injuries in children and teenagers in the United States, 1985-99. Inj Prev. 2002;8(3):185\u2013191.10.1136\/ip.8.3.18512226113"},{"key":"b7","series-title":"NEISS Data Highlights-2017","author":"United States Consumer Product Safety Commission","unstructured":"United States Consumer Product Safety Commission. NEISS Data Highlights-2017. Accessed May 1, 2020. https:\/\/www.cpsc.gov\/s3fs-public\/2017-Neiss-data-highlights.pdf?3i3POG9cN.rIyu2ggrsUkD1XU_zoiFRP"},{"issue":"6","key":"b8","series-title":"Am J Dis Child","first-page":"557","article-title":"Childhood injuries caused by nonpowder firearms","volume":"138","author":"Christoffel KK","year":"1984","unstructured":"Christoffel KK, Tanz R, Sagerman S, Hahn Y. Childhood injuries caused by nonpowder firearms. Am J Dis Child. 1984;138(6):557\u2013561.6720641"},{"issue":"3","key":"b9","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1159\/000222671","article-title":"Significant pediatric morbidity and mortality from intracranial ballistic injuries caused by nonpowder gunshot wounds. A case series","volume":"45","author":"O\u2019Neill PJ","year":"2009","unstructured":"O\u2019Neill PJ, Lumpkin MF, Clapp B,  Significant pediatric morbidity and mortality from intracranial ballistic injuries caused by nonpowder gunshot wounds. A case series. Pediatr Neurosurg. 2009;45(3):205\u2013209.1949456510.1159\/000222671"},{"issue":"4","key":"b10","series-title":"Surg Neurol","first-page":"253","article-title":"Pellet-gun brain wound complicated by Clostridium Perfringens meningitis","volume":"5","author":"DeWeese WO","year":"1976","unstructured":"DeWeese WO, LeBlanc HJ, Kline DG. Pellet-gun brain wound complicated by Clostridium Perfringens meningitis. Surg Neurol. 1976;5(4):253\u2013254.1265638"},{"issue":"1","key":"b11","series-title":"Am Surg","doi-asserted-by":"publisher","first-page":"E33","DOI":"10.1177\/000313481307900118","article-title":"An unusual case of air rifle pellet migration from the brain to the thoracic spine","volume":"79","author":"Lough EG","year":"2013","unstructured":"Lough EG, Glover B, Brown AL. An unusual case of air rifle pellet migration from the brain to the thoracic spine. Am Surg. 2013;79(1):E33\u2013E34.10.1177\/000313481307900118"},{"issue":"4","key":"b12","series-title":"J Trauma","first-page":"344","article-title":"Intracranial bullet migrating to pulmonary artery","volume":"20","author":"Nehme AE","year":"1980","unstructured":"Nehme AE. Intracranial bullet migrating to pulmonary artery. J Trauma. 1980;20(4):344\u2013346.6988604"},{"issue":"9","key":"b13","series-title":"Brain Inj","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1080\/02699050701564509","article-title":"Sudden death following periorbital pellet injury","volume":"21","author":"Tokdemir M","year":"2007","unstructured":"Tokdemir M, T\u00fcrk\u00e7\u00fco\u011flu P, Kafadar H, T\u00fcrko\u011flu A. Sudden death following periorbital pellet injury. Brain Inj. 2007;21(9):997\u2013999.10.1080\/0269905070156450917729052"},{"issue":"5","key":"b14","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1080\/01616412.1999.11740961","article-title":"Incidence of intracranial bullet fragment migration","volume":"21","author":"Rapp LG","year":"1999","unstructured":"Rapp LG, Arce CA, McKenzie R,  Incidence of intracranial bullet fragment migration. Neurol Res. 1999;21(5):475\u2013480.10.1080\/01616412.1999.1174096110439428"},{"issue":"2","key":"b15","series-title":"J Craniofac Surg","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/SCS.0b013e3182413ef8","article-title":"Removal of a low-velocity projectile from the base of the sphenoid sinus using navigation-guided endoscopy","volume":"23","author":"Verhaeghe W","year":"2012","unstructured":"Verhaeghe W, Schepers S, Sun Y,  Removal of a low-velocity projectile from the base of the sphenoid sinus using navigation-guided endoscopy. J Craniofac Surg. 2012;23(2):472\u2013476.10.1097\/SCS.0b013e3182413ef822421844"},{"issue":"10","key":"b16","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"499","DOI":"10.2176\/nmc.41.499","article-title":"Spontaneous migration of a bullet in the cerebellum\u2014case report","volume":"41","author":"Fujimoto Y","year":"2001","unstructured":"Fujimoto Y, Cabrera HT, Pahl FH,  Spontaneous migration of a bullet in the cerebellum\u2014case report. Neurol Med Chir (Tokyo). 2001;41(10):499\u2013501.10.2176\/nmc.41.499"},{"issue":"1","key":"b17","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1097\/00006123-199301000-00024","article-title":"Spontaneous movement of bullets in the brain","volume":"32","author":"Milhorat TH","year":"1993","unstructured":"Milhorat TH, Elowitz EH, Johnson RW, Miller JI. Spontaneous movement of bullets in the brain. Neurosurgery. 1993;32(1):140\u2013143.842154510.1097\/00006123-199301000-00024"},{"issue":"3","key":"b18","series-title":"Neuroradiology","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/BF00341526","article-title":"Spontaneous movement of an intracranial missile","volume":"5","author":"Liebeskind AL","year":"1973","unstructured":"Liebeskind AL, Anderson RD, Schechter MM. Spontaneous movement of an intracranial missile. Neuroradiology. 1973;5(3):129\u2013132.10.1007\/BF003415264718061"},{"key":"b19","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"483","DOI":"10.3171\/jns.1960.17.3.0483","article-title":"Brass foreign body in the brain stem. A case report","volume":"17","author":"Sherman IJ","year":"1960","unstructured":"Sherman IJ. Brass foreign body in the brain stem. A case report. J Neurosurg. 1960;17:483\u2013485.1444588210.3171\/jns.1960.17.3.0483"},{"issue":"6","key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"805","DOI":"10.3171\/jns.1971.34.6.0805","article-title":"Bullet within the fourth ventricle. Case report","volume":"34","author":"Sternbergh WC Jr","year":"1971","unstructured":"Sternbergh WC Jr, Watts C, Clark K. Bullet within the fourth ventricle. Case report. J Neurosurg. 1971;34(6):805\u2013807.10.3171\/jns.1971.34.6.08055314861"},{"issue":"3","key":"b21","series-title":"Am J Forensic Med Pathol","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/01.paf.0000127403.97576.0b","article-title":"Intracranial migrating bullet","volume":"25","author":"Ko\u00e7ak A","year":"2004","unstructured":"Ko\u00e7ak A, \u00d6zer MH. Intracranial migrating bullet. Am J Forensic Med Pathol. 2004;25(3):246\u2013250.10.1097\/01.paf.0000127403.97576.0b15322468"},{"issue":"3-4","key":"b22","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"591.e19","DOI":"10.1016\/j.wneu.2011.06.015","article-title":"Management of migrating intracranial bullets: lessons learned from surviving an AK-47 bullet through the lateral brainstem","volume":"77","author":"Rammo RA","year":"2012","unstructured":"Rammo RA, DeFazio MV, Bullock MR. Management of migrating intracranial bullets: lessons learned from surviving an AK-47 bullet through the lateral brainstem. World Neurosurg. 2012;77(3-4):591.e19\u2013591.e24.10.1016\/j.wneu.2011.06.015"},{"issue":"6","key":"b23","series-title":"World J Surg","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1007\/s00268-014-2874-7","article-title":"Current concepts in penetrating and blast injury to the central nervous system","volume":"39","author":"Rosenfeld JV","year":"2015","unstructured":"Rosenfeld JV, Bell RS, Armonda R. Current concepts in penetrating and blast injury to the central nervous system. World J Surg. 2015;39(6):1352\u20131362.10.1007\/s00268-014-2874-7"},{"issue":"8","key":"b24","series-title":"J Laryngol Otol","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1017\/S0022215107006998","article-title":"Endoscopic removal of foreign body from the anterior cranial fossa","volume":"121","author":"Thomas S","year":"2007","unstructured":"Thomas S, Daudia A, Jones NS. Endoscopic removal of foreign body from the anterior cranial fossa. J Laryngol Otol. 2007;121(8):794\u2013795.10.1017\/S002221510700699817367560"},{"key":"b25","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"1038.e11","DOI":"10.1016\/j.wneu.2017.06.078","article-title":"Endoscopic removal of a bullet that migrated to the third ventricle causing hydrocephalus","volume":"105","author":"Aydoseli A","year":"2017","unstructured":"Aydoseli A, Unal TC, Aras Y,  Endoscopic removal of a bullet that migrated to the third ventricle causing hydrocephalus. World Neurosurg. 2017;105:1038.e11\u20131038.e16.10.1016\/j.wneu.2017.06.078"},{"issue":"1","key":"b26","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1159\/000065104","article-title":"Endoscopically assisted retrieval of an intracranial air gun pellet","volume":"37","author":"Mohanty A","year":"2002","unstructured":"Mohanty A, Manwaring K. Endoscopically assisted retrieval of an intracranial air gun pellet. Pediatr Neurosurg. 2002;37(1):52\u201355.10.1159\/00006510412138222"},{"issue":"4","key":"b27","series-title":"Int J Oral Maxillofac Surg","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.ijom.2006.11.008","article-title":"Removal of a pellet from the left orbital cavity by image-guided endoscopic navigation","volume":"36","author":"Feichtinger M","year":"2007","unstructured":"Feichtinger M, Zemann W, K\u00e4rcher H. Removal of a pellet from the left orbital cavity by image-guided endoscopic navigation. Int J Oral Maxillofac Surg. 2007;36(4):358\u2013361.10.1016\/j.ijom.2006.11.00817229549"},{"issue":"4","key":"b28","series-title":"B-ENT.","first-page":"205","article-title":"Endoscopic removal of air gun pellet in the sphenoid sinus","volume":"1","author":"Strek P","year":"2005","unstructured":"Strek P, Zag\u00f3lski O, Sk\u0142adzie\u0144 J. Endoscopic removal of air gun pellet in the sphenoid sinus. B-ENT. 2005;1(4):205\u2013207.16429755"},{"key":"b29","series-title":"Arch Radiol Electrother","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1259\/are.1916.0003","article-title":"Movements of foreign bodies in the brain","volume":"21","author":"Vilvandr\u00e9 BG","year":"1916","unstructured":"Vilvandr\u00e9 BG, Morgan JD. Movements of foreign bodies in the brain. Arch Radiol Electrother. 1916;21:22\u201327.10.1259\/are.1916.0003"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/26\/4\/article-p445.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/26\/4\/article-p445.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/26\/4\/article-p445.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T17:12:56Z","timestamp":1681578776000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/26\/4\/article-p445.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":29,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2020.4.peds19606","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}