Endoscopically assisted retrieval of an intracranial air gun pellet

Intracranial missile injuries often lodge in deep and inaccessible areas of the brain and are sometimes difficult to remove. Many such missiles are left behind for the fear of surgical morbidity. The authors report the successful removal of a deep-seated intracranial air gun pellet with the aid of an endoscope. A 4-year-old child was admitted after being injured by an air gun pellet in the left forehead. He had no neurological deficits. Cranial CT scan revealed evidence of a pellet lodged in the left frontal region with small bone fragments driven into the adjacent parenchyma. The patient underwent a left frontal craniotomy around the entry wound and debridement of the bone fragments. The track was explored carefully with the aid of a rigid fiberscope and the pellet was identified and removed easily. Postoperatively, the patient had an uneventful recovery. Endoscopic retrieval of the projectile by following the track may be considered a reasonable alternative in suitable cases. This might be useful in retrieving deep-seated missiles.