Penetrating brain injury with machete, stuck to calvarium: Hurdles in imaging and solutions

Penetrating brain injury is a less common form of traumatic brain injury in civilian set up, with a higher mortality and morbidity. A detailed preoperative imaging is warranted to ascertain the extent of injury and involvement of neurovascular structures. We present a rare case of penetrating brain injury with a long machete, who underwent emergency craniotomy, removal of the weapon, debridement and evacuation of the brain contusion and dural repair. Due to the sheer size of the weapon stuck to the calvarium, only X-rays could be performed preoperatively. The difficulties posed by the case, requiring modifications in standard imaging, possible solutions to address the problem and individualized management techniques are discussed in this report.