{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:37:17Z","timestamp":1769726237026,"version":"3.49.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"23","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"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":[[2025,12,8]]},"abstract":"\n BACKGROUND<\/jats:title>\n Nonmissile craniofacial penetrating injuries from elongated metallic objects are uncommon and carry significant risks related to concealed vascular injury, hemorrhage, dural violation, and infection. Early CT and selective vascular imaging guide safe management, and blind extraction outside the operating room (OR) should be avoided.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 17\u2011year\u2011old male presented after transfacial penetration by a \u201csupergun\u201d rod entering inferior to the right zygomatic arch and tracking beneath the temporal squama toward the middle cranial fossa. He arrived with a Glasgow Coma Scale score of 15, an intact airway, and no focal deficits. CT\/CT angiograpy (CTA) showed intracranial extension without major vascular injury. In the OR, a right parietotemporal trauma flap incision enabled a targeted temporal craniotomy; the protruding rod was shortened intraoperatively to reduce lever forces and then extracted along the entry trajectory under direct vision with hemostasis. Postoperative CT imaging revealed a right parietotemporal epidural hematoma adjacent to the craniotomy, which was promptly evacuated. Recovery was otherwise uneventful under a 3\u2011week antibiotic course and 1\u2011month levetiracetam prophylaxis. Follow\u2011up CT imaging at approximately 3 weeks showed resolution and satisfactory healing.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n For elongated metallic skull penetrating injuries, CTA\u2011guided planning, avoidance of blind extraction, and controlled OR removal augmented by intraoperative shortening when needed are key to minimizing hemorrhage and neurological injury.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25670<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25670","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:14:19Z","timestamp":1769685259000},"source":"Crossref","is-referenced-by-count":0,"title":["Transfacial transcranial penetrating fishing arrow injury with intact neurological examination: controlled intraoperative shortening and extraction. Illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3411-6266","authenticated-orcid":true,"given":"Shachar Z.","family":"Shemesh","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Asprilla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Siddiq","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zion","family":"Zibly","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tehila","family":"Kaisman-Elbaz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zvi R.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anton","family":"Wohl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel"},{"name":"Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"AJR Am J Roentgenol","first-page":"1551","article-title":"\u201cWilliam Tell\u201d injury: MDCT of an arrow through the head","volume":"182","author":"de Jongh","year":"2004","unstructured":"de Jongh KDohmen DSalgado R\u201cWilliam Tell\u201d injury: MDCT of an arrow through the head. AJR Am J Roentgenol. 2004;182(6):1551-1553."},{"issue":"1","key":"bib2","series-title":"Anesth Analg","first-page":"231","article-title":"Difficult endotracheal intubation as a result of penetrating craniofacial injury by an arrow","volume":"94","author":"Joly","year":"2002","unstructured":"Joly LMMonod-Broca JPicard LPhilippe HJLaissy JP.Difficult endotracheal intubation as a result of penetrating craniofacial injury by an arrow. Anesth Analg. 2002;94(1):231-232."},{"key":"bib3","series-title":"World Neurosurg","first-page":"761.e5","article-title":"The role of intraoperative cerebral angiography in transorbital intracranial penetrating trauma: a case report and literature review","volume":"97","author":"Riley","year":"2017","unstructured":"Riley JPBoucher ABKim DSBarrow DLReynolds MR.The role of intraoperative cerebral angiography in transorbital intracranial penetrating trauma: a case report and literature review. World Neurosurg. 2017;97:761.e5-761.e10."},{"issue":"3","key":"bib4","series-title":"J Korean Neurosurg Soc","first-page":"180","article-title":"Urgent intracranial carotid artery decompression after penetrating head injury","volume":"53","author":"Kim","year":"2013","unstructured":"Kim SJPark IS.Urgent intracranial carotid artery decompression after penetrating head injury. J Korean Neurosurg Soc. 2013;53(3):180-182."},{"issue":"1","key":"bib5","series-title":"J Neurol Surg Rep","first-page":"23","article-title":"Injury to the temporal lobe via medial transorbital entry of a toothbrush","volume":"74","author":"Skoch","year":"2013","unstructured":"Skoch JAnsay TLLemole GM.Injury to the temporal lobe via medial transorbital entry of a toothbrush. J Neurol Surg Rep. 2013;74(1):23-28."},{"key":"bib6","series-title":"World Neurosurg","first-page":"622.e7","article-title":"Management strategy of a transorbital penetrating pontine injury by a wooden chopstick","volume":"95","author":"Sun","year":"2016","unstructured":"Sun GYagmurlu KBelykh ELei TPreul MC.Management strategy of a transorbital penetrating pontine injury by a wooden chopstick. World Neurosurg. 2016;95:622.e7-622.e15."},{"issue":"1","key":"bib7","series-title":"BMC Surg","first-page":"3","article-title":"Management of screwdriver-induced penetrating brain injury: a case report","volume":"17","author":"Shi","year":"2017","unstructured":"Shi JMao YCao JDong B.Management of screwdriver-induced penetrating brain injury: a case report. BMC Surg. 2017;17(1):3."},{"key":"bib8","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":"suppl 1","key":"bib9","series-title":"J Maxillofac Oral Surg","first-page":"100","article-title":"Penetrating injury of face by a large machine bolt-a rare case report","volume":"14","author":"Tandon","year":"2015","unstructured":"Tandon PNGupta DSJurel SKSrivastava SSharma S.Penetrating injury of face by a large machine bolt-a rare case report. 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J Korean Neurosurg Soc. 2013;53(3):180-182."},{"issue":"1","key":"bib5","series-title":"J Neurol Surg Rep","first-page":"23","article-title":"Injury to the temporal lobe via medial transorbital entry of a toothbrush","volume":"74","author":"Skoch","year":"2013","unstructured":"Skoch JAnsay TLLemole GM.Injury to the temporal lobe via medial transorbital entry of a toothbrush. J Neurol Surg Rep. 2013;74(1):23-28."},{"key":"bib6","series-title":"World Neurosurg","first-page":"622.e7","article-title":"Management strategy of a transorbital penetrating pontine injury by a wooden chopstick","volume":"95","author":"Sun","year":"2016","unstructured":"Sun GYagmurlu KBelykh ELei TPreul MC.Management strategy of a transorbital penetrating pontine injury by a wooden chopstick. 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J Med Case Rep. 2016;10:58."},{"issue":"suppl 1","key":"bib9","series-title":"J Maxillofac Oral Surg","first-page":"100","article-title":"Penetrating injury of face by a large machine bolt-a rare case report","volume":"14","author":"Tandon","year":"2015","unstructured":"Tandon PNGupta DSJurel SKSrivastava SSharma S.Penetrating injury of face by a large machine bolt-a rare case report. J Maxillofac Oral Surg. 2015;14(suppl 1):100-102."},{"key":"bib10","series-title":"World Neurosurg","first-page":"529","article-title":"Nonmissile penetrating injury to the head: experience with 17 cases","volume":"94","author":"Chowdhury","year":"2016","unstructured":"Chowdhury FHHaque MRHossain ZChowdhury NKAlam SMSarker MH.Nonmissile penetrating injury to the head: experience with 17 cases. 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World Neurosurg. 2016;91:297-307."},{"key":"bib13","series-title":"World Neurosurg","first-page":"952.e11","article-title":"Transoral intracranial injury via middle skull base by a blunt chopstick in a child","volume":"103","author":"Samuthrat","year":"2017","unstructured":"Samuthrat TYe KTong Y.Transoral intracranial injury via middle skull base by a blunt chopstick in a child. World Neurosurg. 2017;103:952.e11-952.e17."},{"key":"bib14","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 MEl Mchachi ABenchekroun AAn unusual intracranial metallic foreign bodies and panhypopituitarism. Pan Afr Med J. 2014;19:33."},{"issue":"1","key":"bib15","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. 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