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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.5 São Paulo May 2014 

Images in Neurology

Traumatic brain injury with carotid canal penetrating wound

Traumatismo cranioencefálico com lesão penetrante do canal catotídeo

Wellingson Silva Paiva1 

Iuri Santana Neville1 

Marcelo Prudente1 

Robson Luis Amorim1 

Almir Ferreira de Andrade1 

Manoel Jacobsen Teixeira1 

1Divisão de Neurocirurgia, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo SP, Brazil

Patient male, victim of aggression, comatose, with a screwdriver in his ear canal (Figure 1). CT scan showed a route of the screwdriver through the temporal petrous portion, through the internal carotid artery (ICA) course and a subdural hematoma (Figure 2).

Figure 1 . Photograph showing the screwdriver in the ear canal of the patient before surgery. 

Figure 2 . Computed tomography (CT) showing significant brain swelling with large acute subdural hematoma (arrow) (A). Multiplanar Reconstruction (MPR) of the CT on the axial plane with bone window shows the screwdriver reaching the carotid canal (B). MPR of the CT on the coronal plane with bone window showing the route of the screwdriver in the carotid canal attached to the petrous portion of the temporal bone (C). 

We performed hematoma evacuation, with subsequently intracranial and cervical ICA temporary clipping. We removed the screwdriver without bleeding (Figure 3). A postoperative angiography showed no vascular lesions (Figure 4). In the patient discharge, he had severe disability (Glasgow outcome scale 3).

Figure 3 . Postoperative CT scan shows a left frontotemporoparietal craniotomy with a good radiological result, absence of ischemia or large hematomas, and improvement of brain swelling (A). 3D reconstruction of the CT scan highlights the large craniotomy performed (B). 

Figure 4 . A postoperative angiography showed no vascular lesions. Left anteroposterior internal carotid artery image (A). Internal carotid artery in the petrous segment without injury (B). 

In these cases there is high risk for bleeding1,2,3. So, we believe that combined approach should be performed for safe removal of this penetrating body.


1. Paiva WS, Monaco B, Prudente M, et al. Surgical treatment of a transorbital penetrating brain injury. Clin Ophthalmol 2010;4:1103-1105. [ Links ]

2. Paiva WS, Saad F, Carvalhal ES, De Amorim RL, Figuereido EG, Teixera MJ. Transorbital stab penetrating brain injury. Report of a case. Ann Ital Chir 2009;80:463-465. [ Links ]

3. Bozzeto-Ambrosi P, Costa LF, Azevedo-Filho H. Penetrating screwdriver wound to the head. Arq Neuropsiquiatr 2008;66:93-95. [ Links ]

Received: September 24, 2013; Revised: February 19, 2014; Accepted: March 11, 2014

Correspondence: Wellingson Silva Paiva; Rua Eneas Aguiar 255 / 4079; 05403-010, São Paulo SP, Brasil; E-mail:

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.