Drill bit breakage with tip dislodgment deep into the brain parenchyma: A unique craniotomy complicatıon

Breakage of the drill bit during craniotomies is quite common; however, penetration of the dura and leptomeningeal layers and dislodging of the broken fragment into the brain parenchyma have not been previously reported.

This case report demonstrates a unique and challenging complication in neurosurgery involving a 57-year-old male patient who presented with a large hypertensive intracerebral hemorrhage in the right hemisphere, and intractable intracranial hypertension was taken to the operating room to perform a right decompressive craniectomy and evacuation of intraparenchymal hematoma. During the craniotomy using a disposable, footed B1 drill bit, the drill bit broke and was not found during the surgery. Following the surgical procedure, the routine postoperative computed tomography scan revealed a dislodged drill bit fragment deeply embedded within the frontal lobe parenchyma. The patient was taken again to the operating room. Under fluoroscopy guidance, the drill bit was extracted successfully.

We present this unique case as it can be encountered in daily neurosurgical practice and present our recommendations for management and prevention of such a rare complication, which can be helpful to other neurosurgeons.