Transmastoid pediatric penetrating brain injury, interdisciplinary, and tailored patient’s treatment

Abstract

Background: Pediatric penetrating brain injuries (PBIs) are rare but critical traumatic events, often involving foreign objects. This report will emphasize the clinical presentation, diagnosis, and treatment strategies for pediatric PBI cases. Case Description: This report presents a case of a 7-year-old male patient with a PBI resulting from a nail that penetrated the left mastoid region following a fall from a tree. On admission, the patient maintained consciousness, displayed stable vital signs, and showed no neurological deficits. Crucial radiological examinations, including skull X-rays and head computed tomography (CT) scans, revealed a 6.5 mm caliber nail penetrating 5.5 cm into the brain, with intraventricular hemorrhage filling the bilateral posterior horns of the lateral ventricles. In addition, the CT angiography (CTA) of the head provided a visual of the internal carotid arteries and the vertebrobasilar artery system, obscured by metal artifacts but showing no evidence of thrombus, aneurysm, or vascular malformation. The patient underwent an urgent mastoidectomy and retro sigmoid craniotomy to remove a foreign object, involving a multidisciplinary team. Subsequent to the intervention, the patient sustained full consciousness without neurological impairments and received intensive care. Conclusion: Radiological tools, notably skull X-rays and head CT scans, are pivotal for the precise diagnosis of pediatric PBI. The combined mastoidectomy and retro sigmoid craniotomy approach offers a safe and efficient means of foreign body removal. Tailoring treatments to individual patient needs enhances outcomes.