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Self-Inflicted Drywall Screws in the Sagittal Sinus
1Department of Neurosurgery, Kaiser Permanente/University of California San Francisco, Sacramento, California, USA.
World Neurosurgery
|December 2, 2017
Summary
A man with schizophrenia self-inflicted skull injuries with drywall screws. Both screws were successfully removed without complications, and the patient recovered fully, highlighting the potential for good outcomes even with severe penetrating head trauma.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Psychiatry
Background:
- A 30-year-old male with a history of schizophrenia presented with two self-inflicted drywall screws embedded in his skull.
- The patient had also ingested methamphetamines, as indicated by blood tests.
Observation:
- Computed tomography (CT) and CT angiography revealed the screws' positions: one near the superior sagittal sinus, the other penetrating it.
- Crucially, no contrast extravasation was observed at either screw site, suggesting intact dural venous sinus integrity despite penetration.
Findings:
- Screws were surgically removed via U-shaped craniectomies with direct exposure of the superior sagittal sinus.
- No intraoperative or postoperative bleeding occurred during or after screw removal.
- Histopathological analysis suggested the posterior screw may have entered between the dural leaflets of the superior sagittal sinus.
Implications:
- This case demonstrates successful surgical management of penetrating intracranial trauma involving the superior sagittal sinus.
- It highlights the importance of prompt surgical intervention and meticulous technique in managing such complex injuries.
- The patient's complete recovery underscores the potential for favorable outcomes in selected cases of self-inflicted penetrating head trauma.
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