{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T06:55:54Z","timestamp":1775976954646,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,7,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Transnasal transsphenoidal penetrating craniocerebral injury is very rare even in wartime. Cases with good outcomes are even less common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 20-year-old male sustained multiple fragment wounds to his head and face from a landmine explosion. One metal fragment entered his right nostril, traversed the nasal septum and anterior sphenoid sinus, and ricocheted superiorly off the clivus. The fragment then traveled almost to the surface of the left parietal lobe. Subsequently, under its own weight, it migrated back down its original track. The patient suffered cerebrospinal fluid rhinorrhea, pneumocephalus, and right-sided hemiparesis. Digital subtraction angiography was followed by microscopic transnasal skull base reconstruction supplemented by external lumbar drainage. Follow-up brain computed tomogrpahy showed further metallic fragment migration through the ventricular system. The fragment was removed through a transcortical approach. The patient\u2019s neurological examination and brain magnetic resonance imaging results demonstrated good recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The absence of external signs of deep injuries does not exclude the presence of a penetrating craniocerebral injury. Metal fragments may undergo ricochet and internal migration in both the brain parenchyma and the ventricular system. Timely diagnosis including three-dimensional reconstruction of a projectile\u2019s trajectory may facilitate appropriate surgical planning in complex cases. Intraventricular fragment migration may necessitate microsurgical removal.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24128\">https:\/\/thejns.org\/doi\/10.3171\/CASE24128<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24128","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T02:49:48Z","timestamp":1720406988000},"source":"Crossref","is-referenced-by-count":4,"title":["Wartime penetrating skull base trauma with unpredictable internal fragment ricochet and migration: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Andrii","family":"Sirko","sequence":"first","affiliation":[{"name":"Center for Cerebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex","family":"Valadka","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco","family":"Armonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony J","family":"Dragun","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yurii","family":"Cherednychenko","sequence":"additional","affiliation":[{"name":"Endovascular Center, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2S Suppl 1","key":"bib1","series-title":"J Trauma Acute Care Surg","first-page":"S7","article-title":"Committee on Surgical Combat Casualty Care position statement: neurosurgical capability for the optimal management of traumatic brain injury during deployed operations","volume":"95","author":"Gurney","year":"2023","unstructured":"Gurney JMTadlock MDDengler BA, et al. Committee on Surgical Combat Casualty Care position statement: neurosurgical capability for the optimal management of traumatic brain injury during deployed operations. J Trauma Acute Care Surg. 2023;95(2S Suppl 1):S7-S12."},{"key":"bib2","series-title":"World Neurosurg","first-page":"184","article-title":"Neurosurgery in 21st-entury ars in the Middle East: narrative review of literature","volume":"166","author":"Maroufi","year":"2022","unstructured":"Maroufi SFSohrabi HDabbagh Ohadi MAMohammadi EHabibi Z. Neurosurgery in 21st-entury ars in the Middle East: narrative review of literature. World Neurosurg. 2022;166:184-190."},{"key":"bib3","series-title":"World Neurosurg","first-page":"136","article-title":"How war has shaped neurosurgery","volume":"178","author":"Rainone","year":"2023","unstructured":"Rainone GJZelmanovich RLaurent DLucke-Wold B. How war has shaped neurosurgery. World Neurosurg. 2023;178:136-144."},{"issue":"11","key":"bib4","series-title":"J Sports Med Phys Fitness","first-page":"1494","article-title":"Trans-nasal\u2013trans-sphenoidal brain injury by a fencing foil: an unusual case report and brief literature review","volume":"57","author":"\u00d6zay","year":"2017","unstructured":"\u00d6zay RBalkan MST\u00f6nge \u00c7\u015eekerci Z. Trans-nasal\u2013trans-sphenoidal brain injury by a fencing foil: an unusual case report and brief literature review. J Sports Med Phys Fitness. 2017;57(11):1494-1498."},{"key":"bib5","series-title":"World Neurosurg","first-page":"e329","article-title":"Traumatic brain injury caused by missile wounds in the north of Palestine: a single institution\u2019s experience with 520 consecutive civilian patients","volume":"116","author":"Darwazeh","year":"2018","unstructured":"Darwazeh RDarwazeh MSbeih IYan YWang JSun X. Traumatic brain injury caused by missile wounds in the north of Palestine: a single institution\u2019s experience with 520 consecutive civilian patients. World Neurosurg. 2018116:e329-e339."},{"key":"bib6","series-title":"Trauma Case Rep","first-page":"100330","article-title":"Bullet fragments spontaneously migrating in opposite directions after a cardiac arrest treated with extracorporeal cardiopulmonary resuscitation following a gunshot wound to the head: a case report","volume":"28","author":"Hiramatsu","year":"2020","unstructured":"Hiramatsu T. Bullet fragments spontaneously migrating in opposite directions after a cardiac arrest treated with extracorporeal cardiopulmonary resuscitation following a gunshot wound to the head: a case report. 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Neurol India. 2006;54(4):453-454."},{"issue":"11","key":"bib9","series-title":"Arch Phys Med Rehabil","first-page":"1469","article-title":"Moving bullet syndrome: a complication of penetrating head injury","volume":"79","author":"Zafonte","year":"1998","unstructured":"Zafonte RDWatanabe TMann NR. Moving bullet syndrome: a complication of penetrating head injury. Arch Phys Med Rehabil. 1998;79(11):1469-1472."},{"issue":"5","key":"bib10","series-title":"Neurol Res","first-page":"475","article-title":"Incidence of intracranial bullet fragment migration","volume":"21","author":"Rapp","year":"1999","unstructured":"Rapp LGArce CAMcKenzie RDarmody WRGuyot DRMichael DB. Incidence of intracranial bullet fragment migration. 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Br J Neurosurg. 2021;35(1):119."},{"issue":"3","key":"bib17","series-title":"Neurosurg Rev","first-page":"2417","article-title":"Spontaneous migration of retained intracranial missiles: experience with 16 cases","volume":"45","author":"Darwazeh","year":"2022","unstructured":"Darwazeh RDarwazeh MSun X. Spontaneous migration of retained intracranial missiles: experience with 16 cases. Neurosurg Rev. 2022;45(3):2417-2430."},{"key":"bib18","series-title":"Clin Neurol Neurosurg","first-page":"106607","article-title":"Sinking bullet syndrome: a unique case of transhemispheric migration","volume":"204","author":"Leone","year":"2021","unstructured":"Leone AParsons ADWillis SMoawad SAZanzerkia RRahme R. Sinking bullet syndrome: a unique case of transhemispheric migration. Clin Neurol Neurosurg. 2021;204:106607."},{"issue":"4","key":"bib19","series-title":"World Neurosurg","first-page":"1055","article-title":"Use of a minimally invasive retractor system for retrieval of intracranial fragments in wartime trauma","volume":"84","author":"Rymarczuk","year":"2015","unstructured":"Rymarczuk GNDavidson LSeverson MAArmonda RA. Use of a minimally invasive retractor system for retrieval of intracranial fragments in wartime trauma. World Neurosurg. 2015;84(4):1055-1061."},{"key":"bib20","series-title":"World Neurosurg","first-page":"1038.e11","article-title":"Endoscopic removal of a bullet that migrated to the third ventricle causing hydrocephalus","volume":"105","author":"Aydoseli","year":"2017","unstructured":"Aydoseli AUnal TCAras YSabanci PAAltunrende EIzgi N. Endoscopic removal of a bullet that migrated to the third ventricle causing hydrocephalus. World Neurosurg. 2017;105:1038.e11-1038.e16."},{"issue":"7","key":"bib21","series-title":"J Clin Case Rep","first-page":"564.","article-title":"Migrating intraventricular gunshot pellet: a case report","volume":"5","author":"Esene","year":"2015","unstructured":"Esene INAshour AMYoussef OMahmoud MFahkr A. Migrating intraventricular gunshot pellet: a case report. J Clin Case Rep. 2015;5(7): 564."},{"issue":"Press","key":"bib22","series-title":"J Arch Mil Med","first-page":"e17168","article-title":"A migrating retained intracranial bullet presenting with hydrocephalus and alterations of consciousness: a case report and literature review","volume":"In","author":"Masoudi","year":"2017","unstructured":"Masoudi MSGhafarpasand FYousefi S. A migrating retained intracranial bullet presenting with hydrocephalus and alterations of consciousness: a case report and literature review. 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J Surg Case Rep. 2021;2021(4):rjab105."},{"key":"bib25","series-title":"Surg Neurol Int","first-page":"155","article-title":"Intracerebral bullet removal through an endoscopic transnasal craniectomy","volume":"3","author":"Villaret","year":"2012","unstructured":"Villaret ABZenga FEsposito IRasulo FFontanella MNicolai P. Intracerebral bullet removal through an endoscopic transnasal craniectomy. Surg Neurol Int. 2012;3:155."},{"issue":"5","key":"bib26","series-title":"J Craniofac Surg","first-page":"1800","article-title":"Endoscopic treatment of transnasal intracranial penetrating foreign body","volume":"22","author":"Lee","year":"2011","unstructured":"Lee DHSeo BRLim SC. Endoscopic treatment of transnasal intracranial penetrating foreign body. J Craniofac Surg. 2011;22(5):1800-1801."},{"issue":"8","key":"bib27","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"985","article-title":"Endoscopic transnasal management of intracranial foreign bodies","volume":"130","author":"Dodson","year":"2004","unstructured":"Dodson KMBridges MAReiter ER. Endoscopic transnasal management of intracranial foreign bodies. Arch Otolaryngol Head Neck Surg. 2004;130(8):985-988."},{"issue":"2S Suppl 1","key":"bib1","series-title":"J Trauma Acute Care Surg","first-page":"S7","article-title":"Committee on Surgical Combat Casualty Care position statement: neurosurgical capability for the optimal management of traumatic brain injury during deployed operations","volume":"95","author":"Gurney","year":"2023","unstructured":"Gurney JMTadlock MDDengler BA, et al. Committee on Surgical Combat Casualty Care position statement: neurosurgical capability for the optimal management of traumatic brain injury during deployed operations. J Trauma Acute Care Surg. 2023;95(2S Suppl 1):S7-S12."},{"key":"bib2","series-title":"World Neurosurg","first-page":"184","article-title":"Neurosurgery in 21st-entury ars in the Middle East: narrative review of literature","volume":"166","author":"Maroufi","year":"2022","unstructured":"Maroufi SFSohrabi HDabbagh Ohadi MAMohammadi EHabibi Z. Neurosurgery in 21st-entury ars in the Middle East: narrative review of literature. World Neurosurg. 2022;166:184-190."},{"key":"bib3","series-title":"World Neurosurg","first-page":"136","article-title":"How war has shaped neurosurgery","volume":"178","author":"Rainone","year":"2023","unstructured":"Rainone GJZelmanovich RLaurent DLucke-Wold B. How war has shaped neurosurgery. World Neurosurg. 2023;178:136-144."},{"issue":"11","key":"bib4","series-title":"J Sports Med Phys Fitness","first-page":"1494","article-title":"Trans-nasal\u2013trans-sphenoidal brain injury by a fencing foil: an unusual case report and brief literature review","volume":"57","author":"\u00d6zay","year":"2017","unstructured":"\u00d6zay RBalkan MST\u00f6nge \u00c7\u015eekerci Z. Trans-nasal\u2013trans-sphenoidal brain injury by a fencing foil: an unusual case report and brief literature review. J Sports Med Phys Fitness. 2017;57(11):1494-1498."},{"key":"bib5","series-title":"World Neurosurg","first-page":"e329","article-title":"Traumatic brain injury caused by missile wounds in the north of Palestine: a single institution\u2019s experience with 520 consecutive civilian patients","volume":"116","author":"Darwazeh","year":"2018","unstructured":"Darwazeh RDarwazeh MSbeih IYan YWang JSun X. Traumatic brain injury caused by missile wounds in the north of Palestine: a single institution\u2019s experience with 520 consecutive civilian patients. World Neurosurg. 2018116:e329-e339."},{"key":"bib6","series-title":"Trauma Case Rep","first-page":"100330","article-title":"Bullet fragments spontaneously migrating in opposite directions after a cardiac arrest treated with extracorporeal cardiopulmonary resuscitation following a gunshot wound to the head: a case report","volume":"28","author":"Hiramatsu","year":"2020","unstructured":"Hiramatsu T. Bullet fragments spontaneously migrating in opposite directions after a cardiac arrest treated with extracorporeal cardiopulmonary resuscitation following a gunshot wound to the head: a case report. Trauma Case Rep. 2020;28:100330."},{"issue":"1-2","key":"bib7","series-title":"Ann Neurosci","first-page":"79","article-title":"Migrating souvenir bullet: the management dilemma","volume":"28","author":"Swain","year":"2021","unstructured":"Swain SKArora RKMittal RS. Migrating souvenir bullet: the management dilemma. Ann Neurosci. 2021;28(1-2):79-81."},{"issue":"4","key":"bib8","series-title":"Neurol India","first-page":"453","article-title":"Supratentorial to infratentorial and antigravity migration of intracranial bullet","volume":"54","author":"Yadav","year":"2006","unstructured":"Yadav YRPandey STiwari MAgrawal ANelson A. Supratentorial to infratentorial and antigravity migration of intracranial bullet. Neurol India. 2006;54(4):453-454."},{"issue":"11","key":"bib9","series-title":"Arch Phys Med Rehabil","first-page":"1469","article-title":"Moving bullet syndrome: a complication of penetrating head injury","volume":"79","author":"Zafonte","year":"1998","unstructured":"Zafonte RDWatanabe TMann NR. Moving bullet syndrome: a complication of penetrating head injury. Arch Phys Med Rehabil. 1998;79(11):1469-1472."},{"issue":"5","key":"bib10","series-title":"Neurol Res","first-page":"475","article-title":"Incidence of intracranial bullet fragment migration","volume":"21","author":"Rapp","year":"1999","unstructured":"Rapp LGArce CAMcKenzie RDarmody WRGuyot DRMichael DB. Incidence of intracranial bullet fragment migration. Neurol Res. 1999;21(5):475-480."},{"issue":"3-4","key":"bib11","series-title":"World Neurosurg","first-page":"591.e19","article-title":"Management of migrating intracranial bullets: lessons learned from surviving an AK-47 bullet through the lateral brainstem","volume":"77","author":"Rammo","year":"2012","unstructured":"Rammo RADeFazio MVBullock 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.e19-591.e24."},{"issue":"3-4","key":"bib12","series-title":"World Neurosurg","first-page":"481","article-title":"Practical considerations for the management of migrating intracranial bullets","volume":"77","author":"Moores","year":"2012","unstructured":"Moores LE. Practical considerations for the management of migrating intracranial bullets. 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JNMA J Nepal Med Assoc. 2008;47(171):145-146."},{"issue":"4","key":"bib15","series-title":"Br J Neurosurg","first-page":"381","article-title":"Home-made gun injury: spontaneous version and anterior migration of bullet","volume":"16","author":"Alessi","year":"2002","unstructured":"Alessi GAiyer SNathoo N. Home-made gun injury: spontaneous version and anterior migration of bullet. Br J Neurosurg. 2002;16(4):381-384."},{"issue":"1","key":"bib16","series-title":"Br J Neurosurg","first-page":"119","article-title":"Spontaneous migration of retained intracranial bullet","volume":"35","author":"Choi","year":"2021","unstructured":"Choi BDStapleton CJLee CKWilliams Z. Spontaneous migration of retained intracranial bullet. Br J Neurosurg. 2021;35(1):119."},{"issue":"3","key":"bib17","series-title":"Neurosurg Rev","first-page":"2417","article-title":"Spontaneous migration of retained intracranial missiles: experience with 16 cases","volume":"45","author":"Darwazeh","year":"2022","unstructured":"Darwazeh RDarwazeh MSun X. Spontaneous migration of retained intracranial missiles: experience with 16 cases. Neurosurg Rev. 2022;45(3):2417-2430."},{"key":"bib18","series-title":"Clin Neurol Neurosurg","first-page":"106607","article-title":"Sinking bullet syndrome: a unique case of transhemispheric migration","volume":"204","author":"Leone","year":"2021","unstructured":"Leone AParsons ADWillis SMoawad SAZanzerkia RRahme R. Sinking bullet syndrome: a unique case of transhemispheric migration. 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J Arch Mil Med. 2017;In(Press):e17168."},{"issue":"4","key":"bib23","series-title":"J Neurosurg Pediatr","first-page":"445","article-title":"Navigation-guided neuroendoscopic removal of an intracranial migratory pellet from the thalamus of a 4- year-old girl","volume":"26","author":"Duddleston","year":"2020","unstructured":"Duddleston PJGendreau JLLittle KAAndrews AThompson WD. Navigation-guided neuroendoscopic removal of an intracranial migratory pellet from the thalamus of a 4- year-old girl. J Neurosurg Pediatr. 2020;26(4):445-448."},{"issue":"4","key":"bib24","series-title":"J Surg Case Rep","first-page":"rjab105","article-title":"Spontaneous migration of a falling bullet in the cerebellum reveals the importance of intraoperative skull X-ray","volume":"2021","author":"Hammed","year":"2021","unstructured":"Hammed AMahfoud MSulaiman A. Spontaneous migration of a falling bullet in the cerebellum reveals the importance of intraoperative skull X-ray. 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