Nail Penetration in the Superior Sagittal Sinus: A Case Report of a Nail Gun Injury

The number of penetrating brain injuries (PBI) is low, and the materials of PBI, including bullets, nails, chopsticks, wood, and missiles, vary widely. We report a case in which a nail penetrated the superior sagittal sinus (SSS) and advanced between the cerebral falx but was managed favorably. A 25-year-old male was bruised by a nail gun falling on his head, triggering the ejection of a 3-inch nail into his head. He presented with no symptoms other than mild bleeding and head pain. The patient did not notice the nail injection. Computed tomography (CT) and angiogram revealed that the nail entered parallel to the midline in the interhemispheric fissure through SSS, and there was no intracranial hemorrhage. A bilateral frontoparietal craniotomy was performed with the nail left fixed to the skull. After confirming that the cerebral falx enveloped the entire length of the nail, we extirpated it and sealed the entrance to the SSS. The patient recovered with no neurological deficits, and postoperative images confirmed preservation of the antegrade venous return of the SSS. We observed a case of nail penetration in the SSS. It was essential to perform a thorough imaging examination and the extraction under direct observation using a microscope.