{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T17:11:10Z","timestamp":1770916270212,"version":"3.50.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"13","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"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":[[2025,3,31]]},"abstract":"\n BACKGROUND<\/jats:title>\n Penetrating head trauma caused by blast injuries can result in intracranial foreign bodies (FBs), which pose significant risks, including CSF leaks, pneumocephalus, and infections, particularly when paranasal sinuses are involved.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 54-year-old male sustained a blast injury in Ukraine, resulting in shrapnel embedded in the sella turcica. The trajectory of the shrapnel traversed the right medial orbital wall into the ethmoid and sphenoid sinuses, ultimately reaching the sella and causing a skull base defect with CSF rhinorrhea. CT imaging revealed subarachnoid hemorrhage and severe pneumocephalus. Because of the FB\u2019s proximity to the cavernous sinus and pituitary gland, the decision was made to leave the FB and repair the defect via a microscopic endonasal transseptal transsphenoidal approach with a fascial and muscle graft given that a nasoseptal flap was not possible. The patient experienced no neurological or endocrinological sequelae with complete resolution of the pneumocephalus.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The microscopic endonasal transsphenoidal approach is a safe and effective technique for managing skull base defects resulting from penetrating trauma, achieving resolution of pneumocephalus, and preventing meningitis. Decisions regarding FB removal should be individualized, prioritizing patient recovery while minimizing neurovascular risks.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24875<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24875","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T23:48:01Z","timestamp":1743464881000},"source":"Crossref","is-referenced-by-count":1,"title":["Microscopic endonasal transsphenoidal approach for repair of sellar defect from penetrating trauma during wartime: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6536-2035","authenticated-orcid":true,"given":"Andrii","family":"Sirko","sequence":"first","affiliation":[{"name":"Center for \u0421erebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0305-6508","authenticated-orcid":true,"given":"Isabelle","family":"Pelcher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwell Health, Manhasset, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6739-0793","authenticated-orcid":true,"given":"Ehsan","family":"Dowlati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwell Health, Manhasset, New York"},{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rostislav","family":"Malyi","sequence":"additional","affiliation":[{"name":"Center for \u0421erebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco A.","family":"Armonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC"},{"name":"Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"J Neurosurg Case Lessons","first-page":"CASE24128","article-title":"Wartime penetrating skull base trauma with unpredictable internal fragment ricochet and migration: illustrative case","volume":"8","author":"Sirko","year":"2024","unstructured":"Sirko AValadka AArmonda RDragun AJCherednychenko Y.Wartime penetrating skull base trauma with unpredictable internal fragment ricochet and migration: illustrative case. J Neurosurg Case Lessons. 2024;8(2):CASE24128."},{"issue":"10","key":"bib2","series-title":"J Oral Maxillofac Surg","first-page":"2067","article-title":"Management of penetrating war injuries: bullet\/shell fragments in the sphenoid sinuses","volume":"66","author":"Shuker","year":"2008","unstructured":"Shuker ST.Management of penetrating war injuries: bullet\/shell fragments in the sphenoid sinuses. J Oral Maxillofac Surg. 2008;66(10):2067-2072."},{"issue":"3","key":"bib3","series-title":"Emerg Radiol","first-page":"301","article-title":"A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment","volume":"24","author":"Vakil","year":"2017","unstructured":"Vakil MTSingh AK.A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol. 2017;24(3):301-309."},{"issue":"3","key":"bib4","series-title":"J Neurosurg","first-page":"829","article-title":"Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine","volume":"142","author":"Sirko","year":"2025","unstructured":"Sirko ABerlin CTsang SNaik BIArmonda R.Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine. J Neurosurg. 2025;142(3):829-836."},{"key":"bib5","series-title":"Surg Neurol Int","first-page":"555","article-title":"Transbasal penetrating traumatic brain injury caused by a rifle rod: a case report","volume":"13","author":"Al-Alousi","year":"2022","unstructured":"Al-Alousi HMAl-Kubaisi KTIsmail MTransbasal penetrating traumatic brain injury caused by a rifle rod: a case report. Surg Neurol Int. 2022;13:555."},{"key":"bib6","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":"bib7","series-title":"Med Oral Patol Oral Cir Bucal","first-page":"E397","article-title":"Cerebrospinal fluid rhinorrhoea: diagnosis and management","volume":"12","author":"Abuabara","year":"2007","unstructured":"Abuabara A.Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal. 2007;12(5):E397-E400."},{"issue":"2","key":"bib8","series-title":"Skull Base","first-page":"125","article-title":"Transnasal transsphenoidal endoscopic repair of CSF leakage using multilayer acellular dermis","volume":"17","author":"Ismail","year":"2007","unstructured":"Ismail ASCostantino PDSen C.Transnasal transsphenoidal endoscopic repair of CSF leakage using multilayer acellular dermis. Skull Base. 2007;17(2):125-132."},{"key":"bib9","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. 2018;116:e329-e339."},{"key":"bib10","series-title":"J Neurosurg","article-title":"Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine","author":"Sirko","year":"2025","unstructured":"Sirko ACherednychenko YDowlati EArmonda RA.Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine. J Neurosurg. Published online February 28, 2025. doi:10.3171\/2024.10.JNS241938"},{"issue":"1","key":"bib11","series-title":"J Clin Med","first-page":"46","article-title":"Endoscopic skull base repair strategy for CSF leaks associated with pneumocephalus","volume":"10","author":"G\u00e2ta","year":"2020","unstructured":"G\u00e2ta AToader CTrombita\u0219 VEIlyes AAlbu S.Endoscopic skull base repair strategy for CSF leaks associated with pneumocephalus. J Clin Med. 2020;10(1):46."},{"issue":"2","key":"bib12","series-title":"Acute Crit Care","first-page":"244","article-title":"What should an intensivist know about pneumocephalus and tension pneumocephalus?","volume":"38","author":"Wankhade","year":"2023","unstructured":"Wankhade BSBeniamein MMKAlrais ZFMathew JIAlrais GZ.What should an intensivist know about pneumocephalus and tension pneumocephalus? Acute Crit Care. 2023;38(2):244-248."},{"key":"bib13","series-title":"Pan Afr Med J","first-page":"33","article-title":"An unusual intracranial metallic foreign bodies and panhypopituitarism","volume":"19","author":"Lakouichmi","year":"2014","unstructured":"Lakouichmi MBa\u00efzri HMouhsine ABoukhira AAkhaddar A.An unusual intracranial metallic foreign bodies and panhypopituitarism. Pan Afr Med J. 2014;19:33."},{"issue":"3","key":"bib14","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":"bib15","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. 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J Oral Maxillofac Surg. 2008;66(10):2067-2072."},{"issue":"3","key":"bib3","series-title":"Emerg Radiol","first-page":"301","article-title":"A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment","volume":"24","author":"Vakil","year":"2017","unstructured":"Vakil MTSingh AK.A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. 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Surg Neurol Int. 2022;13:555."},{"key":"bib6","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":"bib7","series-title":"Med Oral Patol Oral Cir Bucal","first-page":"E397","article-title":"Cerebrospinal fluid rhinorrhoea: diagnosis and management","volume":"12","author":"Abuabara","year":"2007","unstructured":"Abuabara A.Cerebrospinal fluid rhinorrhoea: diagnosis and management. 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World Neurosurg. 2018;116:e329-e339."},{"key":"bib10","series-title":"J Neurosurg","article-title":"Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine","author":"Sirko","year":"2025","unstructured":"Sirko ACherednychenko YDowlati EArmonda RA.Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine. J Neurosurg. Published online February 28, 2025. doi:10.3171\/2024.10.JNS241938"},{"issue":"1","key":"bib11","series-title":"J Clin Med","first-page":"46","article-title":"Endoscopic skull base repair strategy for CSF leaks associated with pneumocephalus","volume":"10","author":"G\u00e2ta","year":"2020","unstructured":"G\u00e2ta AToader CTrombita\u0219 VEIlyes AAlbu S.Endoscopic skull base repair strategy for CSF leaks associated with pneumocephalus. J Clin Med. 2020;10(1):46."},{"issue":"2","key":"bib12","series-title":"Acute Crit Care","first-page":"244","article-title":"What should an intensivist know about pneumocephalus and tension pneumocephalus?","volume":"38","author":"Wankhade","year":"2023","unstructured":"Wankhade BSBeniamein MMKAlrais ZFMathew JIAlrais GZ.What should an intensivist know about pneumocephalus and tension pneumocephalus? Acute Crit Care. 2023;38(2):244-248."},{"key":"bib13","series-title":"Pan Afr Med J","first-page":"33","article-title":"An unusual intracranial metallic foreign bodies and panhypopituitarism","volume":"19","author":"Lakouichmi","year":"2014","unstructured":"Lakouichmi MBa\u00efzri HMouhsine ABoukhira AAkhaddar A.An unusual intracranial metallic foreign bodies and panhypopituitarism. 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