[A Case of Transoral Penetrating Head Injury from a Crossbow-Fired Arrow]

Penetrating head injuries are extremely rare in Japan. The authors describe a case involving a penetrating head injury from an arrow fired from a crossbow. A 52-year-old man who had shot himself transorally in a suicide attempt was admitted to the authors' hospital. On admission, he was conscious and exhibited no neurological deficits. The end of the arrow was visible inside his oral cavity. Computed tomography revealed the arrow had penetrated the right cerebellum and occipital lobe, resulting in a very small hematoma. Digital subtraction angiography revealed no significant vascular injuries. After considering these findings and the nature of the object, the authors decided to remove the arrow from the cranium by pulling it from the patient's oral cavity. To remove the arrow, surgery was performed with several devices, including intraoperative X-ray, endoscopy, and intraoperative angiography. The authors were able to completely remove the arrow, and the patient experienced no new deficits, except mild ataxia and mild dysphasia, and no signs of cerebral infection or cerebrospinal fluid leakage after the surgery. Although most cases of penetrating head injuries require craniotomies, the authors were able to safely remove the foreign object in this case without performing a craniotomy. Because guidelines for the treatment of penetrating head injuries have not been established, the treatment of each case must be modified according to the nature of the foreign object and the findings of preoperative imaging techniques.