Delayed surgical removal of a penetrating brain spear injury in a resource-limited hospital: a case report from Papua New Guinea

Background Penetrating brain injuries pose immense management challenges in resource-limited hospitals, if advanced imaging such as computed tomography, angiograms, or magnetic resonance imaging are unavailable. Case Presentation A 22-year-old male presented with a brain injury resulting from a steel spear that penetrated the right temporal region and exited through the occipital region. The patient maintained his consciousness, showed stable vitals and indicated no neurological deficits throughout the admission. Management As it was not possible for the patient to be moved to a hospital with advanced imaging facilities, the removal of the spear was delayed for 30 days to allow for wound granulation to repair possibly damaged blood vessels. During that period, the patient was conservatively managed with antibiotics after teleconsultations with neurosurgeons. The spear was then removed with the assistance of a drill. Outcome The patient did not develop any complications either immediately or short term, and remained without any neurological deficits on subsequent follow-ups. Conclusion Delayed surgical removal of foreign bodies in penetrating brain injury may be feasible in haemodynamically stable patients when advanced imaging and vascular control is lacking. Appropriate antibiotic cover and remote consultation with multidisciplinary teams may be vital for such successful patient management.