Low-Velocity Penetrating Cranial Trauma With a Retained Axe: Surgical Management and Operative Challenges in a...

Penetrating brain injury (PBI) is a rare but potentially life-threatening form of traumatic brain injury characterized by violation of the skull and dura by a foreign object. Civilian penetrating head injuries caused by low-velocity objects such as knives, rods, or tools are uncommon and present unique diagnostic and surgical challenges. We report the case of a 23-year-old man who presented with a retained axe embedded in the right parietal region following an assault. On arrival, the patient was conscious with a Glasgow Coma Scale score of 15 but had left-sided hemiparesis. Non-contrast computed tomography (CT) of the head demonstrated a depressed right parietal fracture with a penetrating metallic foreign body extending intracranially. Emergency surgical exploration with controlled removal of the retained object, debridement of devitalized tissue, and dural repair was performed. The postoperative course was uneventful, and the patient was discharged on the tenth postoperative day with a healthy wound and stable neurological status, although residual hemiparesis persisted. At 15-day follow-up, no new neurological deficits were noted. This case highlights the importance of careful imaging evaluation, controlled extraction of penetrating objects along their trajectory, and meticulous dural repair. However, given the single-case nature and short follow-up, these findings should be interpreted with caution. In this patient, non-contrast CT was deemed sufficient as the trajectory was away from major intracranial vascular structures and no radiological indicators of vascular injury were identified.