An uncommon cause of penetrating brain injury: two cases of nail gun injuries. Illustrative cases

BACKGROUND Low-velocity penetrating brain injury (PBI) is an uncommon variant of traumatic brain injury (TBI). Patients affected by PBI can present with highly variable injury patterns, which, along with guideline-directed TBI care, may require the employment of unique operative management strategies. There are no strict guidelines for the management of low-velocity penetrating injuries. Characterizing approaches and outcomes for various injury patterns may be of use in guiding surgical decision-making. The authors report their experience with two cases of PBI by mechanism of a nail gun with a retained intracranial foreign body requiring surgical removal. OBSERVATIONS The two patients were managed using different operative approaches with directly visualized nail removal, and both cases were managed with different empiric antibiotic regimens. Both patients were neurologically intact at follow-up and had no perioperative complications. LESSONS These cases illustrate two methods of foreign body removal and the perioperative management protocol utilized at the authors' institution.