- Transnasal penetrating brain injuries are exceedingly rare, carry high mortality risk and major neurosurgical and infectious complications, and demand urgent multidisciplinary management.
- Early CT diagnosis and meticulous preoperative planning enable safe endoscopic endonasal removal of retained intracranial foreign bodies and targeted skull base reconstruction.
- Repair of CSF leak with fascia lata and tissue adhesive achieves reliable anterior skull base closure; psychiatric treatment is essential after self-inflicted injury.
Life (Basel). 2026 Aug 12;16(8):1321. doi: 10.3390/life16081321.
ABSTRACT
Introduction: Transnasal penetrating intracranial injuries represent an exceptionally rare form of traumatic brain injury, characterized by high mortality and a substantial risk of severe neurosurgical and infectious complications. Self-inflicted injuries involving the penetration of a foreign body through the nasal cavity into the brain are exceedingly uncommon and require prompt diagnosis and a multidisciplinary treatment approach. Objective: This study aimed to present a rare clinical case of transnasal penetration of a foreign body (a ballpoint pen refill) into the brain parenchyma during a suicide attempt, and to describe the diagnostic and therapeutic approach. Case Report: A 46-year-old woman with an acute psychotic disorder was admitted following a suicide attempt involving the insertion of a ballpoint pen refill through the right nasal cavity. Computed tomography revealed a retained intracranial foreign body embedded within the brain parenchyma, traversing the cribriform plate and associated with pneumocephalus. The foreign body was successfully removed via an endoscopic endonasal approach. Owing to the cerebrospinal fluid leak that developed after removal of the foreign body, reconstruction of the anterior skull base defect was performed using fascia lata and tissue adhesive. The postoperative course was uneventful, with no neurological complications and gradual resolution of the intracerebral hemorrhagic changes and pneumocephalus. The patient was discharged without neurological deficits and was referred for psychiatric treatment with a diagnosis of catatonia accompanied by episodes of psychomotor agitation. Conclusions: Transnasal penetrating brain injuries are rare but potentially fatal. Early radiological diagnosis, meticulous preoperative planning, and an endoscopic endonasal approach enable safe removal of the foreign body and reliable reconstruction of the anterior skull base defect. Multidisciplinary collaboration among neurosurgeons, otorhinolaryngologists, radiologists, and psychiatrists is essential for achieving favorable outcomes in these patients.
PMID:42653009 | DOI:10.3390/life16081321
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