{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:36:44Z","timestamp":1769726204309,"version":"3.49.0"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"22","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"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 Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Penetrating cranial trauma through the orbit presents significant diagnostic and surgical challenges, especially when external signs are minimal. Blast injuries may drive foreign bodies (FBs) along unpredictable trajectories, risking vascular injury, intracranial hematoma, CSF leak, and infection. Prompt imaging and early multidisciplinary intervention are critical for avoiding complications and sequelae.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 24-year-old sustained a blast injury from mortar fire, resulting in a 10-cm nail penetrating his skull base. Remarkably, he walked 7 km to a medical facility, presenting with a 2.5-cm submandibular wound. CT revealed the nail had traversed the superior orbital fissure into both the anterior and middle cranial fossae, causing a right subdural hematoma, complete ophthalmoplegia, amaurosis, and sylvian venous injury. Angiography ruled out any arterial injury. The patient underwent a wide frontotemporal craniotomy for decompression and safe mobilization of the FB. Dural and skull base reconstruction was performed at two sites using autologous muscle and a vascularized pericranial flap.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Penetrating orbital wounds can obscure life-threatening intracranial trauma and may present with different trajectories involving multiple craniofacial compartments. Thin-cut CT imaging and early cerebral angiography are essential for diagnosis, and multidisciplinary planning is critical for safe and effective intervention for FB removal and reconstruction.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25577<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25577","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:11:07Z","timestamp":1769685067000},"source":"Crossref","is-referenced-by-count":0,"title":["Operative management of a nail wound projectile to the skull base with unusual trajectory: illustrative case"],"prefix":"10.3171","volume":"10","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\/0009-0004-3786-1477","authenticated-orcid":true,"given":"Sebastian","family":"Leon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwell Health, Manhasset, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mykyta","family":"Hulidin","sequence":"additional","affiliation":[{"name":"Center for \u0421erebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bohdan","family":"Sirko","sequence":"additional","affiliation":[{"name":"Center for \u0421erebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine"}],"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, MedStar Georgetown University Hospital, Washington, DC"},{"name":"Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC"}],"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":"1","key":"bib1","series-title":"J R Army Med Corps","first-page":"5","article-title":"Improving survivability from blast injury: \u2018shifting the goalposts\u2019 and the need for interdisciplinary research","volume":"165","author":"Pearce","year":"2019","unstructured":"Pearce APClasper J.Improving survivability from blast injury: \u2018shifting the goalposts\u2019 and the need for interdisciplinary research. J R Army Med Corps. 2019;165(1):5-6."},{"issue":"1","key":"bib2","series-title":"BMC Public Health","first-page":"578","article-title":"Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data","volume":"20","author":"MacGregor","year":"2020","unstructured":"MacGregor AJZouris JMWatrous JRMultimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data. BMC Public Health. 2020;20(1):578."},{"issue":"2","key":"bib3","series-title":"J Neurol Surg","first-page":"431","article-title":"Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine","volume":"143","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 Neurol Surg. 2025;143(2):431-442."},{"key":"bib4","series-title":"Case Rep Ophthalmol Med","first-page":"742186","article-title":"Transorbital craniocerebral occult penetrating injury with cerebral abscess complication","volume":"2012","author":"Abdulbaki","year":"2012","unstructured":"Abdulbaki AAl-Otaibi FAlmalki AAlohaly NBaeesa S.Transorbital craniocerebral occult penetrating injury with cerebral abscess complication. Case Rep Ophthalmol Med. 2012;2012:742186."},{"key":"bib5","series-title":"Front Surg","first-page":"533567","article-title":"Minimally invasive subtemporal intradural approach for penetrating orbitocranial injury by wooden foreign body into the lateral wall of the cavernous sinus","volume":"7","author":"Avraham","year":"2020","unstructured":"Avraham ESmolikov ASmolyakov RMinimally invasive subtemporal intradural approach for penetrating orbitocranial injury by wooden foreign body into the lateral wall of the cavernous sinus. Front Surg. 2020;7:533567."},{"issue":"1","key":"bib6","series-title":"Nagoya J Med Sci","first-page":"179","article-title":"Transorbital penetrating head injury by a wooden chopstick in the cavernous sinus: a case report and literature review","volume":"85","author":"Yamazaki","year":"2023","unstructured":"Yamazaki DOgihara NYako TTransorbital penetrating head injury by a wooden chopstick in the cavernous sinus: a case report and literature review. Nagoya J Med Sci. 2023;85(1):179-184."},{"issue":"3","key":"bib7","series-title":"VSP","first-page":"301","article-title":"Minimally invasive treatment of transorbital penetrating injury of skull base and cavernous sinus: a case report","volume":"79","author":"Jelaca","year":"2022","unstructured":"Jelaca BDjilvesi DVladimir PPajicic FLepic MVulekovic P.Minimally invasive treatment of transorbital penetrating injury of skull base and cavernous sinus: a case report. VSP. 2022;79(3):301-304."},{"issue":"1","key":"bib8","series-title":"Neurotrauma Rep","first-page":"240","article-title":"Rationale and methods for updated guidelines for the management of penetrating traumatic brain injury","volume":"3","author":"Hawryluk","year":"2022","unstructured":"Hawryluk GWJSelph SLumba-Brown ARationale and methods for updated guidelines for the management of penetrating traumatic brain injury. 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Am J Case Rep. 2024;26."},{"issue":"3","key":"bib18","series-title":"J Neurosurg Case Lessons","first-page":"CASE22440","article-title":"Transorbital penetrating head injury with a favorable outcome: illustrative case","volume":"5","author":"Lohkamp","year":"2023","unstructured":"Lohkamp LNHolowka SWidjaja EManicat-Emo ARutka JT.Transorbital penetrating head injury with a favorable outcome: illustrative case. J Neurosurg Case Lessons. 2023;5(3):CASE22440."},{"issue":"22","key":"bib19","series-title":"Disabil Rehabil","first-page":"6642","article-title":"Effect of an oculomotor rehabilitation program for subacute brain injury patients with ophthalmoplegia: a case-control study","volume":"44","author":"Watabe","year":"2022","unstructured":"Watabe TSuzuki HSako RAbe MAoki KYoda M.Effect of an oculomotor rehabilitation program for subacute brain injury patients with ophthalmoplegia: a case-control study. 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BMC Public Health. 2020;20(1):578."},{"issue":"2","key":"bib3","series-title":"J Neurol Surg","first-page":"431","article-title":"Early multimodal neurointerventional and neurosurgical management of penetrating craniocerebral injuries: wartime experience from Ukraine","volume":"143","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 Neurol Surg. 2025;143(2):431-442."},{"key":"bib4","series-title":"Case Rep Ophthalmol Med","first-page":"742186","article-title":"Transorbital craniocerebral occult penetrating injury with cerebral abscess complication","volume":"2012","author":"Abdulbaki","year":"2012","unstructured":"Abdulbaki AAl-Otaibi FAlmalki AAlohaly NBaeesa S.Transorbital craniocerebral occult penetrating injury with cerebral abscess complication. Case Rep Ophthalmol Med. 2012;2012:742186."},{"key":"bib5","series-title":"Front Surg","first-page":"533567","article-title":"Minimally invasive subtemporal intradural approach for penetrating orbitocranial injury by wooden foreign body into the lateral wall of the cavernous sinus","volume":"7","author":"Avraham","year":"2020","unstructured":"Avraham ESmolikov ASmolyakov RMinimally invasive subtemporal intradural approach for penetrating orbitocranial injury by wooden foreign body into the lateral wall of the cavernous sinus. Front Surg. 2020;7:533567."},{"issue":"1","key":"bib6","series-title":"Nagoya J Med Sci","first-page":"179","article-title":"Transorbital penetrating head injury by a wooden chopstick in the cavernous sinus: a case report and literature review","volume":"85","author":"Yamazaki","year":"2023","unstructured":"Yamazaki DOgihara NYako TTransorbital penetrating head injury by a wooden chopstick in the cavernous sinus: a case report and literature review. Nagoya J Med Sci. 2023;85(1):179-184."},{"issue":"3","key":"bib7","series-title":"VSP","first-page":"301","article-title":"Minimally invasive treatment of transorbital penetrating injury of skull base and cavernous sinus: a case report","volume":"79","author":"Jelaca","year":"2022","unstructured":"Jelaca BDjilvesi DVladimir PPajicic FLepic MVulekovic P.Minimally invasive treatment of transorbital penetrating injury of skull base and cavernous sinus: a case report. VSP. 2022;79(3):301-304."},{"issue":"1","key":"bib8","series-title":"Neurotrauma Rep","first-page":"240","article-title":"Rationale and methods for updated guidelines for the management of penetrating traumatic brain injury","volume":"3","author":"Hawryluk","year":"2022","unstructured":"Hawryluk GWJSelph SLumba-Brown ARationale and methods for updated guidelines for the management of penetrating traumatic brain injury. Neurotrauma Rep. 2022;3(1):240-247."},{"key":"bib9","series-title":"F1000Res","article-title":"Case report: transorbital approach for the management of an orbito-temporal penetrating brain injury (skull base region) secondary to wooden spikes","volume":"10","author":"Apriawan","year":"2021","unstructured":"Apriawan THafid Bajamal ADarlan DRamadhan Y.Case report: transorbital approach for the management of an orbito-temporal penetrating brain injury (skull base region) secondary to wooden spikes. F1000Res. 2021;10:1283."},{"issue":"4","key":"bib10","series-title":"Digit J Ophthalmol","first-page":"9","article-title":"Diagnosis and treatment of penetrating orbital cranial foreign body injuries","volume":"18","author":"Lefebvre","year":"2012","unstructured":"Lefebvre DRChandra RV.Diagnosis and treatment of penetrating orbital cranial foreign body injuries. Digit J Ophthalmol. 2012;18(4):9-11."},{"issue":"1","key":"bib11","series-title":"Ann Surg","first-page":"66","article-title":"Review paper on penetrating brain injury: ethical quandaries in the trauma bay and beyond","volume":"277","author":"Zakrison","year":"2023","unstructured":"Zakrison TLEssig RPolcari AReview paper on penetrating brain injury: ethical quandaries in the trauma bay and beyond. Ann Surg. 2023;277(1):66-72."},{"issue":"2","key":"bib12","series-title":"Ann Med Surg (Lond)","first-page":"924","article-title":"Complex orbitocranial penetrating injury-managed through neuroplastic surgery\u2014a rare case report and review of literature","volume":"87","author":"Udhay","year":"2025","unstructured":"Udhay PSathyabal VCKodeeswaran OSMPriyadharshan KPChaurasia B.Complex orbitocranial penetrating injury-managed through neuroplastic surgery\u2014a rare case report and review of literature. Ann Med Surg (Lond). 2025;87(2):924-928."},{"issue":"3","key":"bib13","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):829-838."},{"issue":"2","key":"bib14","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":"6","key":"bib15","series-title":"J Neurosurg Case Lessons","first-page":"CASE24520","article-title":"Self-inflicted bilateral penetrating brain injury with a nail gun in an African American male: illustrative case","volume":"9","author":"Schultz","year":"2025","unstructured":"Schultz AWroblewski THOnonogbu-Uche FCSelf-inflicted bilateral penetrating brain injury with a nail gun in an African American male: illustrative case. J Neurosurg Case Lessons. 2025;9(6):CASE24520."},{"issue":"11","key":"bib16","series-title":"J Neurosurg Case Lessons","first-page":"CASE24692","article-title":"Hybrid endovascular and open surgical management of retained stab wounds: illustrative case","volume":"9","author":"Hosseini","year":"2025","unstructured":"Hosseini EMAghamiri SHKoosha MHasanpour MFarajzadeh M.Hybrid endovascular and open surgical management of retained stab wounds: illustrative case. J Neurosurg Case Lessons. 2025;9(11):CASE24692."},{"key":"bib17","series-title":"Am J Case Rep","article-title":"Successful surgical management of intracranial carotid artery trauma following penetrating facial injury: a case report","volume":"26","author":"Hopper","year":"2024","unstructured":"Hopper WSpagnolia AADrofa ATerrellAM.Successful surgical management of intracranial carotid artery trauma following penetrating facial injury: a case report. Am J Case Rep. 2024;26."},{"issue":"3","key":"bib18","series-title":"J Neurosurg Case Lessons","first-page":"CASE22440","article-title":"Transorbital penetrating head injury with a favorable outcome: illustrative case","volume":"5","author":"Lohkamp","year":"2023","unstructured":"Lohkamp LNHolowka SWidjaja EManicat-Emo ARutka JT.Transorbital penetrating head injury with a favorable outcome: illustrative case. J Neurosurg Case Lessons. 2023;5(3):CASE22440."},{"issue":"22","key":"bib19","series-title":"Disabil Rehabil","first-page":"6642","article-title":"Effect of an oculomotor rehabilitation program for subacute brain injury patients with ophthalmoplegia: a case-control study","volume":"44","author":"Watabe","year":"2022","unstructured":"Watabe TSuzuki HSako RAbe MAoki KYoda M.Effect of an oculomotor rehabilitation program for subacute brain injury patients with ophthalmoplegia: a case-control study. 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