{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:14:36Z","timestamp":1769732076293,"version":"3.49.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T00:00:00Z","timestamp":1732492800000},"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":[[2024,11,25]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intracranial penetrating injuries from a pencil are exceptionally rare. The most common mechanism is a child running while holding a pencil. Potential consequences of intracranial pencil injury include direct trauma to brain structures, vascular injury, and intracranial abscess formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 3-year-old girl was at daycare and had fallen while running with a pencil. Computed tomography showed a pencil penetrating the left parietal bone through the left temporal lobe, terminating in the posterior limb of the internal capsule. Cerebral angiography was performed prior to the removal of the pencil to rule out vascular injury. Angiography of the left carotid artery revealed slight irregularity in the left M2 but no active extravasation. The patient was then taken to the operating room to have the pencil removed. Postoperatively, she did well and was discharged home after 6 days with no neurological deficits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Pencils are rare causes of intracranial injury in children. Definitive vascular imaging prior to pencil removal to rule out vascular injury and minimize the risk of hemorrhage after removal is recommended. Intraoperative irrigation and debridement, followed by antibiotics, are recommended to avoid abscess formation. Follow-up vascular imaging is recommended to rule out pseudoaneurysm.<\/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\/CASE24494\">https:\/\/thejns.org\/doi\/10.3171\/CASE24494<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24494","type":"journal-article","created":{"date-parts":[[2024,11,25]],"date-time":"2024-11-25T13:04:57Z","timestamp":1732539897000},"source":"Crossref","is-referenced-by-count":0,"title":["Penetrating intracranial injury from a pencil in a pediatric patient: illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Eva","family":"Liu","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsuan Ming","family":"Su","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Toyota","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Braeden D.","family":"Newton","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Coote","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Marciniuk","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed Uzair","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lissa","family":"Peeling","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Surg Neurol","first-page":"427","article-title":"Intracranial pencil injuries","volume":"16","author":"Bursick","year":"1981","unstructured":"Bursick DMSelker RG. Intracranial pencil injuries. Surg Neurol. 1981;16(6):427-431."},{"issue":"4","key":"bib2","series-title":"Pediatr Neurosurg","first-page":"307","article-title":"Pencil in the brain: a case of temporal lobe abscess following an intracranial penetrating pencil injury","volume":"47","author":"Gupta","year":"2011","unstructured":"Gupta AChacko AAnil MSKaranth SSShetty A. Pencil in the brain: a case of temporal lobe abscess following an intracranial penetrating pencil injury. Pediatr Neurosurg. 2011;47(4):307-308."},{"issue":"7","key":"bib3","series-title":"N Engl J Med","first-page":"342","article-title":"Broken pencil points as a cause of brain abscess","volume":"271","author":"Horner","year":"1964","unstructured":"Horner FABerry RGFrantz M. Broken pencil points as a cause of brain abscess. N Engl J Med. 1964;271(7):342-345."},{"issue":"5","key":"bib4","series-title":"Ann Saudi Med","first-page":"534","article-title":"Oro-cranial penetrating pencil injury","volume":"32","author":"Aremu","year":"2012","unstructured":"Aremu SKMakusid MMIbe IC. Oro-cranial penetrating pencil injury. Ann Saudi Med. 2012;32(5):534-536."},{"issue":"2","key":"bib5","series-title":"Br J Neurosurg","first-page":"159","article-title":"Transnasal penetrating brain injury with a ball-pen","volume":"14","author":"Sharif","year":"2000","unstructured":"Sharif GRoberts JPhillips S. Transnasal penetrating brain injury with a ball-pen. Br J Neurosurg. 2000;14(2):159-160."},{"issue":"4","key":"bib6","series-title":"Rom Neurosurg","first-page":"545","article-title":"Unusual cranial trauma caused by pencil in teenager: case report","volume":"31","author":"Rashid","year":"2017","unstructured":"Rashid ASAbdelrazaq SSHoz SS, et al. Unusual cranial trauma caused by pencil in teenager: case report. Rom Neurosurg. 2017;31(4):545-550."},{"issue":"2","key":"bib7","series-title":"J Craniofac Surg","first-page":"e109","article-title":"A late-onset seizure due to a retained intracranial foreign body\u2014pencil lead: a case report and review","volume":"25","author":"Chunhua","year":"2014","unstructured":"Chunhua QQun W. A late-onset seizure due to a retained intracranial foreign body\u2014pencil lead: a case report and review. J Craniofac Surg. 2014;25(2):e109-e110."},{"key":"bib8","series-title":"World Neurosurg","first-page":"611.e1","article-title":"Transnasal penetration of a ballpoint pen: case report and review of literature","volume":"96","author":"Nguyen","year":"2016","unstructured":"Nguyen HSOni-Orisan ADoan NMueller W. Transnasal penetration of a ballpoint pen: case report and review of literature. World Neurosurg. 2016;96:611.e1-611.e10."},{"issue":"2","key":"bib9","series-title":"Forensic Sci Med Pathol","first-page":"221","article-title":"\u201cThe pen is mightier than the sword\u201d\u2014suicidal trans-orbital intracranial penetrating injury from a pencil","volume":"14","author":"Cvetkovi\u0107","year":"2018","unstructured":"Cvetkovi\u0107 D\u017divkovi\u0107 VDamjanjuk INikoli\u0107 S. \u201cThe pen is mightier than the sword\u201d\u2014suicidal trans-orbital intracranial penetrating injury from a pencil. Forensic Sci Med Pathol. 2018;14(2):221-224."},{"issue":"3","key":"bib10","series-title":"J Int Med Res","first-page":"0300060519886210","article-title":"Penetrating transorbital injury by a coloring pencil in a 3-year-old child: a case report","volume":"48","author":"Huang","year":"2020","unstructured":"Huang TLing JLiu M, et al. Penetrating transorbital injury by a coloring pencil in a 3-year-old child: a case report. 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Rom Neurosurg. 2017;31(4):545-550."},{"issue":"2","key":"bib7","series-title":"J Craniofac Surg","first-page":"e109","article-title":"A late-onset seizure due to a retained intracranial foreign body\u2014pencil lead: a case report and review","volume":"25","author":"Chunhua","year":"2014","unstructured":"Chunhua QQun W. A late-onset seizure due to a retained intracranial foreign body\u2014pencil lead: a case report and review. J Craniofac Surg. 2014;25(2):e109-e110."},{"key":"bib8","series-title":"World Neurosurg","first-page":"611.e1","article-title":"Transnasal penetration of a ballpoint pen: case report and review of literature","volume":"96","author":"Nguyen","year":"2016","unstructured":"Nguyen HSOni-Orisan ADoan NMueller W. Transnasal penetration of a ballpoint pen: case report and review of literature. 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