• Kenji Miki, Yoshihiro Natori, Yasutoshi Kai, Megumu Mori, Tetsuhisa Yamada, and Naoki Noguchi.
• Department of Neurosurgery, Aso Iizuka Hospital, Iizuka, Fukuoka, Japan. Electronic address: mickeydreamk@yahoo.co.jp.
• World Neurosurg. 2019 Jul 1; 127: 442-445.

BackgroundThe incidence of penetrating intracranial foreign bodies is rare, and to date, not many relevant studies have been published worldwide. In particular, a nail penetrating intracranially, just near the superior sagittal sinus (SSS), is extremely rare. We treated the case of a large nail that penetrated the middle of the head and strategized its removal.Case DescriptionA 70-year-old man had experienced headache lasting a day. Computed tomography of the brain revealed a nail penetrating the middle of his head; in particular, the tip of the nail had penetrated the right ventricle, causing a slight subarachnoid hemorrhage. Angiography showed that the nail was very close to the SSS and that the venous flow was normal. However, there was a risk of the nail penetrating through the SSS or injuring other arteries, and we removed the nail directly from the intracranial view to stop bleeding from the SSS or other vessels. Fortunately, there was no bleeding, and we washed the hole created by the nail penetration and concluded the surgery.ConclusionsOur technique is useful and safe for removing large nails penetrating the head.Copyright © 2019 Elsevier Inc. All rights reserved.

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