Background Deliberate self-harm with stone- or hammer-driven nail through the cranium is unusual. The need is stressed for comprehensive radiological evaluation with computed tomography (CT) scan, with or without angiography, and removal through an open cranial procedure under general anaesthesia, rather than extraction through a burrhole under local anesthetic infiltration. Methods We present here a 27-year old male who presented at our Teaching Hospital setting with a self-inflicted hand-driven intracranial nail to the left parietal region. He had a detailed neurological examination, was evaluated pre-operatively with computerised tomography of the brain and underwent an open cranial procedure under general anaesthesia for nail retrieval. Psychiatric unit evaluated and managed him for chronic depression. Results The transparietal, intraventricular 10cm long nail was retrieved and associated abscess evacuated by an open cranial procedure. Pre-operative neurological impairments regressed and his mood stabilized with anti-depressants. He was discharged without further deficits and has remained well for over four years Conclusion Self-inflicted hand-driven intracranial nail is a very rare form of penetrating cranio-cerebral trauma. Preoperative computerised tomography scan of the brain, meticulous open cranial removal under general anaesthesia and psychiatric management enable discharge without further injury or deficits. On the other hand, removal through a burrhole or just pulling out the nail would not allow intraoperative visualisation of associated lesions; the latter also predispose to further vascular and parenchymal brain injuries, worsening neurolological impairments. Key words: Intracranial Nail; Open Cranial Procedure; Psychiatric Evaluation.
{"title":"10.4314/ajns.v9i2.70411","authors":"","doi":"10.4314/ajns.v9i2.70411","DOIUrl":"https://doi.org/10.4314/ajns.v9i2.70411","url":null,"abstract":"Background Deliberate self-harm with stone- or hammer-driven nail through the cranium is unusual. The need is stressed for comprehensive radiological evaluation with computed tomography (CT) scan, with or without angiography, and removal through an open cranial procedure under general anaesthesia, rather than extraction through a burrhole under local anesthetic infiltration. Methods We present here a 27-year old male who presented at our Teaching Hospital setting with a self-inflicted hand-driven intracranial nail to the left parietal region. He had a detailed neurological examination, was evaluated pre-operatively with computerised tomography of the brain and underwent an open cranial procedure under general anaesthesia for nail retrieval. Psychiatric unit evaluated and managed him for chronic depression. Results The transparietal, intraventricular 10cm long nail was retrieved and associated abscess evacuated by an open cranial procedure. Pre-operative neurological impairments regressed and his mood stabilized with anti-depressants. He was discharged without further deficits and has remained well for over four years Conclusion Self-inflicted hand-driven intracranial nail is a very rare form of penetrating cranio-cerebral trauma. Preoperative computerised tomography scan of the brain, meticulous open cranial removal under general anaesthesia and psychiatric management enable discharge without further injury or deficits. On the other hand, removal through a burrhole or just pulling out the nail would not allow intraoperative visualisation of associated lesions; the latter also predispose to further vascular and parenchymal brain injuries, worsening neurolological impairments. Key words: Intracranial Nail; Open Cranial Procedure; Psychiatric Evaluation.","PeriodicalId":42149,"journal":{"name":"African Journal of Neurological Sciences","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/ajns.v9i2.70411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42491527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Le craniopharyngiome est une tumeur benigne qui provient de nids epitheliaux ou de zones de metaplasies squameuses liees a l’embryogenese hypophysaire. Touchant surtout l’enfant, peut etre potentiellement agressive et caracterisee par un taux eleve de recidive apres traitement chirurgical. La bleomycine represente une des molecules de chimiotherapie utilisee souvent dans le traitement insitu dans le craniopharyngiome kystique. L’objectif de notre etude est d’evaluer les resultats clinique et radiologique du traitement d’un craniopharyngiome par la bleomycine et comparer notre experience a celle de la litterature. Observation Nous avons analyse le dossier de la patiente B. Rania âgee de 11 ans. Elle presente un craniopharyngiome kystique intra et supra sellaire a extension frontale, traite par chimiotherapie intra tumorale (bleomycine), durant la periode allant de 2003 a 2004 et suivi jusqu’a present au service de neurochirurgie du CHU de Annaba- Algerie. Resultat La patiente presentait a son admission une hypertension intracrânienne et une somnolence depuis 24 heures d’ou sa ponction en urgence a travers le reservoir d’Ommaya deja place auparavant dans un autre service de neurochirurgie. Quatre mois plus tard, la patiente a beneficie d’un cycle de chimiotherapie etale sur une periode de 20 jours, la dose totale de bleomycine etait de 51,5mg soit 2 a 3 mg par dose avec un espacement de 48 a 72 heures ; le volume de la tumeur avant la chimiotherapie etait de 46 mm dans son grand axe, a la fin du traitement par la bleomycine, nous constatons une calcification total du kyste apres un controle scannographique en 2007. Conclusion Le traitement du craniopharyngiome par la bleomycine insitu a donne des resultats satisfaisants. Notre experience est la premiere a l’echelle nationale. En esperant que cette experience se generalise en Algerie afin de mieux nous eclaires a l’avenir. Mots cles : Craniopharyngiome, reservoir d’Ommaya, bleomycine, calcification.
{"title":"10.4314/ajns.v9i2.70409","authors":"","doi":"10.4314/ajns.v9i2.70409","DOIUrl":"https://doi.org/10.4314/ajns.v9i2.70409","url":null,"abstract":"Introduction Le craniopharyngiome est une tumeur benigne qui provient de nids epitheliaux ou de zones de metaplasies squameuses liees a l’embryogenese hypophysaire. Touchant surtout l’enfant, peut etre potentiellement agressive et caracterisee par un taux eleve de recidive apres traitement chirurgical. La bleomycine represente une des molecules de chimiotherapie utilisee souvent dans le traitement insitu dans le craniopharyngiome kystique. L’objectif de notre etude est d’evaluer les resultats clinique et radiologique du traitement d’un craniopharyngiome par la bleomycine et comparer notre experience a celle de la litterature. Observation Nous avons analyse le dossier de la patiente B. Rania âgee de 11 ans. Elle presente un craniopharyngiome kystique intra et supra sellaire a extension frontale, traite par chimiotherapie intra tumorale (bleomycine), durant la periode allant de 2003 a 2004 et suivi jusqu’a present au service de neurochirurgie du CHU de Annaba- Algerie. Resultat La patiente presentait a son admission une hypertension intracrânienne et une somnolence depuis 24 heures d’ou sa ponction en urgence a travers le reservoir d’Ommaya deja place auparavant dans un autre service de neurochirurgie. Quatre mois plus tard, la patiente a beneficie d’un cycle de chimiotherapie etale sur une periode de 20 jours, la dose totale de bleomycine etait de 51,5mg soit 2 a 3 mg par dose avec un espacement de 48 a 72 heures ; le volume de la tumeur avant la chimiotherapie etait de 46 mm dans son grand axe, a la fin du traitement par la bleomycine, nous constatons une calcification total du kyste apres un controle scannographique en 2007. Conclusion Le traitement du craniopharyngiome par la bleomycine insitu a donne des resultats satisfaisants. Notre experience est la premiere a l’echelle nationale. En esperant que cette experience se generalise en Algerie afin de mieux nous eclaires a l’avenir. Mots cles : Craniopharyngiome, reservoir d’Ommaya, bleomycine, calcification.","PeriodicalId":42149,"journal":{"name":"African Journal of Neurological Sciences","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2020-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/ajns.v9i2.70409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43251223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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