Diagnostic Evaluation and Surgical Management of Self-Inflicted Trans-Frontal Sinus Penetrating Brain Injury in a Patient with Schizophrenia

Background: Non-missile penetrating traumatic brain injury (pTBI) is a rare but life-threatening condition. In self-inflicted cases involving the frontal sinus, a rigorous preoperative diagnostic workup is crucial to assess foreign body fragmentation, trajectory, and potential vascular compromise. The complexities of such cases demand a highly structured approach to prevent severe secondary brain injury and long-term infectious sequelae. Case Presentation: A 36-year-old male with schizophrenia presented after attempting suicide by stabbing a kitchen knife through his frontal sinus. Multimodal diagnostic imaging was immediately employed. Skull radiographs and computed tomography (CT) precisely delineated the blade traversing the frontal sinus and entering the anterior cranial fossa. Crucially, given the proximity to the skull base, digital subtraction angiography (DSA) was proactively performed, which confirmed the absence of major cerebrovascular injury and safely guided the surgical strategy. Based on these precise imaging findings, a bifrontal craniotomy was performed. During the procedure, the main blade was extracted, and a retained broken metallic tip—recognized upon close intraoperative inspection of the extracted blade—was successfully retrieved from the intracranial compartment. Postoperative wound infections (with causative pathogens isolated as Serratia odorifera and coagulase-negative Staphylococci) were effectively eradicated with targeted antibiotics. The patient achieved a favorable neurological recovery. Conclusions: Multimodal neuroimaging, particularly the combination of CT and DSA, can be highly beneficial in the diagnostic workup of complex pTBI. Precise preoperative imaging helps guide the optimal surgical approach, ensuring complete foreign body removal and minimizing severe secondary complications. Early intervention, guided by standardized imaging and followed by aggressive medical management, can yield positive outcomes even in severely morbid presentations.