Delayed presentation of bamboo foreign body in brainstem, with novel skull base foramen

We describe the extremely unusual case of a childhood injury to the skull base presenting after many years, as a foreign body with chronic granulomatous infection of the brainstem, mimicking neoplasm. TB had an inconsequential penetrating injury to the left cheek, from a bamboo spike aged 15. After 4 years, he developed worsening left sided weakness, imaging at this time was normal. After a car accident aged 40, the weakness worsened further and imaging demonstrated a foreign body entering the skull base. At its tip, it had caused a chronic granulomatous reaction within the brainstem. Surgical removal of this bamboo splinter was via an infratemporal, transzygomatic craniotomy and TB made a good recovery postoperatively. This unusual case demonstrates the important of close inspection of imaging, and thorough history taking. It also questions the chronology of the ossification of the skull base.