Stab wounds to the skull and brain have become extremely uncommon. Unlike cranio cerebral missile inju-ries, low velocity penetrating stab wounds damage a focal area along the tract. Although the nature and shape of offensive instru-ments are variable, generally over 90 percent of injurie result from an assault, and knives are the predominant weapon used. The most appropriate management in the field is to leave the instrument in situ and carefully transport the patient to a well-equipped trauma center.

We present a patient admitted with a knife embedded in

the skull Penetrating brain injury (PBI) includes all traumatic brain injuries which are not the result of a blunt mechanism. Although less prevalent than closed head trauma, PBI carries a worse prognosis. In civilian populations, PBIs are mostly caused by high velocity ob-jects, which result in more complex injuries and high mortality. PBI caused by non-missile, low-velocity objects represents a rare pathol-ogy among civilians, with better outcome because of more localized primary injury, and is usually caused by violence, accidents, or even suicide attempts. Optimum management of PBI requires a good understanding of the mechanism of injury and its pathophysiology

27-year-old male was admitted to the emergency department of ULIN General

Hospital with a knife embedded in the right cheek pointing anterior and upwards. Neuroimaging showed no vascular impairment. After obtaining informed consent, the knife was removed. Postoperative neurological findings showed no deficit. No infection occurred. Brain stab wounds cause numerous complications, such as intracranial hemorrhage, injury of important vessels, and infections. Minimal blade movement during removal and precautions to prevent massive hemorrhage are essential. Injuries in the maxillofacial and brain stab wound with knife in situ are not common. We report a rare case with knife impacted in the, mandible, maxilla and penetrate skull base with its tip reaching the temporal lobe of the brain .

Early recognition and management of stab wounds to the brain is essential to ensure an optimal outcome. If the weapon has been removed, the wound can be missed on physical examination The stab wounds are particu-larly dangerous because of short distance to the brain stem and vascular structures.

In this case the knife was in a direction such that no damage to vital structures occurred. The penetration site, depth of penetration, type of object, transorbital trajectory, and other factors may be important in determining the outcome. Brain stab wounds mainly cause intracranial hemorrhage, injury of important vessels, and infection. Infection frequently results from penetration of objects through the air sinus or oropharyngeal mucosa, All previous pa-tients could be treated with intravenous antibiotics. However, patients with septic complications sometimes developed brain abscess.

The cardinal principle is that no attempt should be undertaken to remove the offending instrument until care full investigation is done, and the surgeon is prepared to remove the instrument with an appropriate surgical plan. During operation, care must be taken not to produce any rocking move-ment which may be transmitted to the tip of the instrument, and removal should retrace the original trajectory of the weapon. The fundamental princi-ples of surgical management include the prevention of early or late infection, thorough debridement of necrotic tissue and hematoma, removal of all acces-sible bone fragments and foreign body and meticulous closure to prevent cerebrospinal fluid fistula. Blind removal of the penetrating object is danger-ous, because blind removal may rock or twist the object, resulting in second-

INTRACRANIAL PENETRATING STAB WOUND

Case Report

Aditya Y*, Suhendar A**

* RESIDENCE OF GENERAL SURGERY OF PADJAJARAN UNIVERSITY , ULIN Banjarmasin General Hospital ** CONSULTAN OF NEUROSURGERY OF LAMBUNG MANGKURAT UNIVERSITY , Ulin Banjarmasin General Hospital

INTRODUCTION

ABSTRACT

DISCUSSION

REFERENCES 1. Esposito DP, Walker JP. Contemporary management of penetrating brain injury. Neurosurg Q. 2009;19:249–54. 2. Part 2. Prognosis in penetrating brain injury. J Trauma. 2001;51:S44–86. 3. Part 1: Guidelines for the management of penetrating brain injury. Introduction a nd methodology. J Trauma. 2001;51:S1–6. .