Syringe needle located deep in the brain: image-guided removal

Removal of a thin but long foreign body lodged in the deep brain tissue may need special technique to remove it without causing major injury. We report a special technique for the safe, elective removal of such objects.

A 5-year-old boy presented following mild head trauma; he was asymptomatic and physical examination revealed an intact scalp and no neurological deficit. The incidental presence of a 3.4 cm-long syringe needle in the right frontal region was noted on the skull radiographs. Cranial computed tomography (CT) scan showed the deeper end of the needle in the right caudate head and the superficial end at a depth of 3.5 cm from the cortical surface. Burr hole surgery was performed under general anesthesia employing a Fisher stereotactic frame and continuous biplanar guidance from the image intensifiers. The superficial end of the needle was clasped with an endoscopy biopsy forceps, allowing removal of the needle via the least traumatic route. The child had an uneventful recovery. Follow-up magnetic resonance imaging at 6 months did not reveal any abnormality.

The two-dimensional biplanar image-guided stereotactic technique allowed safe removal of a long foreign body from a deep brain location with minimal trauma to the brain.