{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T23:55:16Z","timestamp":1770162916994,"version":"3.49.0"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"17","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"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":[[2025,4,28]]},"abstract":"\n BACKGROUND<\/jats:title>\n The authors discuss the first reported case of a large, high-grade arteriovenous malformation (AVM) in the dominant hemisphere, discovered incidentally after a penetrating nail gun injury.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The patient underwent surgical removal of a nail lodged in the right frontal lobe. A contralateral AVM was diagnosed on his perioperative imaging and was evaluated further with diagnostic cerebral angiography. Because of the location of the AVM within the dominant fronto-opercular region, the patient underwent a super-selective Wada test to evaluate for the risk of expressive language deficit prior to undergoing a successful resection of the AVM. He had an excellent recovery from both surgeries without any neurological deficits.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case illustrates the importance of continued suspicion for incidental findings when reviewing imaging, despite the presence of a known and obvious pathology. The observations add nuance to the standard considerations for surgical intervention for penetrating nail gun injuries, and the workup for incidentally found vascular lesions is reviewed.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24850<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24850","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T20:14:20Z","timestamp":1745871260000},"source":"Crossref","is-referenced-by-count":0,"title":["Improbable discovery of an incidental high-grade AVM: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"given":"Max S","family":"Fleisher","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, George Washington University, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayes H.","family":"Patrick","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, George Washington University, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edinson","family":"Najera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lehigh Valley Hospital Network, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6774-2066","authenticated-orcid":true,"given":"Walter C.","family":"Jean","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lehigh Valley Hospital Network, Allentown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Neurosurgery","first-page":"529","article-title":"The application of the novel grading scale (Lawton-Young grading system) to predict the outcome of brain arteriovenous malformation","volume":"84","author":"Hafez","year":"2019","unstructured":"Hafez AKoroknay-P\u00e1l POulasvirta EThe application of the novel grading scale (Lawton-Young grading system) to predict the outcome of brain arteriovenous malformation. Neurosurgery. 2019;84(2):529-536."},{"key":"bib2","series-title":"Handb Clin Neurol","first-page":"15","article-title":"The natural history of cerebral arteriovenous malformations","volume":"143","author":"Can","year":"2017","unstructured":"Can AGross BADu R.The natural history of cerebral arteriovenous malformations. Handb Clin Neurol. 2017;143:15-24."},{"key":"bib3","series-title":"Clin Imaging","first-page":"155","article-title":"Positive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization","volume":"51","author":"Bican","year":"2018","unstructured":"Bican OCho CLee LPositive pharmacologic provocative testing with methohexital during cerebral arteriovenous malformation embolization. Clin Imaging. 2018;51:155-159."},{"issue":"3-4","key":"bib4","series-title":"World Neurosurg","first-page":"276","article-title":"Utility of pharmacologic provocative neurological testing before embolization of occipital lobe arteriovenous malformations","volume":"76","author":"Tawk","year":"2011","unstructured":"Tawk RGTummala RPMemon MZSiddiqui AHHopkins LNLevy EI.Utility of pharmacologic provocative neurological testing before embolization of occipital lobe arteriovenous malformations. 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J Med Case Rep. 2016;10:58."},{"issue":"3","key":"bib7","series-title":"J Saf Res","first-page":"241","article-title":"Continued progress in the prevention of nail gun injuries among apprentice carpenters: what will it take to see wider spread injury reductions?","volume":"41","author":"Lipscomb","year":"2010","unstructured":"Lipscomb HJNolan JPatterson DDement JM.Continued progress in the prevention of nail gun injuries among apprentice carpenters: what will it take to see wider spread injury reductions? J Saf Res. 2010;41(3):241-245."},{"key":"bib8","article-title":"Nail Gun Safety: A Guide for Construction Contractors","unstructured":"National Institute for Occupational Safety and Health, Occupational Safety and Health Administration. Nail Gun Safety: A Guide for Construction Contractors. 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Surg Neurol. 2005;63(6):550-553."},{"issue":"5","key":"bib19","series-title":"Arch Iran Med","first-page":"252","article-title":"CT scan incidental findings in head trauma patients\u2014Yazd Shahid Rahnemoun hospital, 2005-2015","volume":"22","author":"Razavi-Ratki","year":"2019","unstructured":"Razavi-Ratki SKArefmanesh ZNamiranian NCT scan incidental findings in head trauma patients\u2014Yazd Shahid Rahnemoun hospital, 2005-2015. Arch Iran Med. 2019;22(5):252-254."},{"issue":"2","key":"bib20","series-title":"Pediatrics","first-page":"e356","article-title":"Incidental findings in children with blunt head trauma evaluated with cranial CT scans","volume":"132","author":"Rogers","year":"2013","unstructured":"Rogers AJMaher COSchunk JEIncidental findings in children with blunt head trauma evaluated with cranial CT scans. Pediatrics. 2013;132(2):e356-e363."},{"issue":"5","key":"bib21","series-title":"J Neurosurg Pediatr","first-page":"463","article-title":"A comparison of incidental and symptomatic unruptured brain arteriovenous malformations in children","volume":"31","author":"Lu","year":"2023","unstructured":"Lu AYWinkler EAGarcia JHA comparison of incidental and symptomatic unruptured brain arteriovenous malformations in children. J Neurosurg Pediatr. 2023;31(5):463-468."},{"issue":"2","key":"bib1","series-title":"Neurosurgery","first-page":"529","article-title":"The application of the novel grading scale (Lawton-Young grading system) to predict the outcome of brain arteriovenous malformation","volume":"84","author":"Hafez","year":"2019","unstructured":"Hafez AKoroknay-P\u00e1l POulasvirta EThe application of the novel grading scale (Lawton-Young grading system) to predict the outcome of brain arteriovenous malformation. 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World Neurosurg. 2011;76(3-4):276-281."},{"issue":"3","key":"bib5","series-title":"AJNR Am J Neuroradiol","first-page":"470","article-title":"Provocative test with propofol: experience in patients with cerebral arteriovenous malformations who underwent neuroendovascular procedures","volume":"31","author":"Feliciano","year":"2010","unstructured":"Feliciano CEde Le\u00f3n-Berra RHern\u00e1ndez-Gait\u00e1n MSTorres HMCreagh ORodr\u00edguez-Mercado R.Provocative test with propofol: experience in patients with cerebral arteriovenous malformations who underwent neuroendovascular procedures. AJNR Am J Neuroradiol. 2010;31(3):470-475."},{"key":"bib6","series-title":"J Med Case Rep","article-title":"Nail gun injuries to the head with minimal neurological consequences: a case series","volume":"10","author":"Makoshi","year":"2016","unstructured":"Makoshi ZAlKherayf FDa Silva VLesiuk H.Nail gun injuries to the head with minimal neurological consequences: a case series. J Med Case Rep. 2016;10:58."},{"issue":"3","key":"bib7","series-title":"J Saf Res","first-page":"241","article-title":"Continued progress in the prevention of nail gun injuries among apprentice carpenters: what will it take to see wider spread injury reductions?","volume":"41","author":"Lipscomb","year":"2010","unstructured":"Lipscomb HJNolan JPatterson DDement JM.Continued progress in the prevention of nail gun injuries among apprentice carpenters: what will it take to see wider spread injury reductions? J Saf Res. 2010;41(3):241-245."},{"key":"bib8","article-title":"Nail Gun Safety: A Guide for Construction Contractors","unstructured":"National Institute for Occupational Safety and Health, Occupational Safety and Health Administration. Nail Gun Safety: A Guide for Construction Contractors. 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Brain Inj. 2021;35(2):164-172."},{"issue":"1","key":"bib11","series-title":"BMJ Case Rep","first-page":"e237122","article-title":"Treatment of a self-inflicted intracranial nail gun injury","volume":"14","author":"Zhu","year":"2021","unstructured":"Zhu RCYoshida MCKopp MLin N.Treatment of a self-inflicted intracranial nail gun injury. BMJ Case Rep. 2021;14(1):e237122."},{"key":"bib12","series-title":"Surg Neurol Int","first-page":"377","article-title":"Thirty-two nails injected into the head: an operative report and review of the literature","volume":"13","author":"Zima","year":"2022","unstructured":"Zima LASrinivasan SBudde BKitagawa R.Thirty-two nails injected into the head: an operative report and review of the literature. Surg Neurol Int. 2022;13:377."},{"issue":"1","key":"bib13","series-title":"AJNR Am J Neuroradiol","first-page":"164","article-title":"Value of angiography in cerebral nail-gun injuries","volume":"7","author":"Al-Mefty","year":"1986","unstructured":"Al-Mefty OHoloubi AFox JL.Value of angiography in cerebral nail-gun injuries. AJNR Am J Neuroradiol. 1986;7(1):164-165."},{"issue":"8","key":"bib14","series-title":"BMJ Case Rep","first-page":"e243789","article-title":"Traumatic intracranial nail-gun injury of the right internal carotid artery causing pseudoaneurysm and caroticocavernous fistula","volume":"14","author":"Brooks","year":"2021","unstructured":"Brooks CADower ABonura AManning NVan Gelder J.Traumatic intracranial nail-gun injury of the right internal carotid artery causing pseudoaneurysm and caroticocavernous fistula. BMJ Case Rep. 2021;14(8):e243789."},{"issue":"3","key":"bib15","series-title":"Br J Neurosurg","first-page":"448","article-title":"Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note","volume":"37","author":"Nussbaum","year":"2023","unstructured":"Nussbaum ESGraupman PPatel PD.Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note. Br J Neurosurg. 2023;37(3):448-452."},{"issue":"3","key":"bib16","series-title":"Oper Neurosurg (Hagerstown)","first-page":"e223","article-title":"Nailed through superior sagittal sinus: a case report and surgical considerations","volume":"24","author":"Kow","year":"2023","unstructured":"Kow CYHakim JSAspoas ARBrew SMcGuinness BCorreia J.Nailed through superior sagittal sinus: a case report and surgical considerations. Oper Neurosurg (Hagerstown). 2023;24(3):e223-e227."},{"issue":"2","key":"bib17","series-title":"Korean J Neurotrauma","first-page":"137","article-title":"Head injury by pneumatic nail gun: a case report","volume":"10","author":"Kim","year":"2014","unstructured":"Kim TWShim YSOh SYHyun DKPark HSKim EY.Head injury by pneumatic nail gun: a case report. Korean J Neurotrauma. 2014;10(2):137-138."},{"issue":"6","key":"bib18","series-title":"Surg Neurol","first-page":"550","article-title":"Incidental findings in brain computed tomography scans of 3000 head trauma patients","volume":"63","author":"Eskandary","year":"2005","unstructured":"Eskandary HSabba MKhajehpour FEskandari M.Incidental findings in brain computed tomography scans of 3000 head trauma patients. Surg Neurol. 2005;63(6):550-553."},{"issue":"5","key":"bib19","series-title":"Arch Iran Med","first-page":"252","article-title":"CT scan incidental findings in head trauma patients\u2014Yazd Shahid Rahnemoun hospital, 2005-2015","volume":"22","author":"Razavi-Ratki","year":"2019","unstructured":"Razavi-Ratki SKArefmanesh ZNamiranian NCT scan incidental findings in head trauma patients\u2014Yazd Shahid Rahnemoun hospital, 2005-2015. Arch Iran Med. 2019;22(5):252-254."},{"issue":"2","key":"bib20","series-title":"Pediatrics","first-page":"e356","article-title":"Incidental findings in children with blunt head trauma evaluated with cranial CT scans","volume":"132","author":"Rogers","year":"2013","unstructured":"Rogers AJMaher COSchunk JEIncidental findings in children with blunt head trauma evaluated with cranial CT scans. 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