Navigation-guided neuroendoscopic removal of an intracranial migratory pellet from the thalamus of a 4-year-old girl

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  • 1 School of Medicine, Mercer University, Macon; and
  • 2 Neurological and Spine Institute of Savannah, Georgia
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Extraction of a bullet fragment seated in deep brain parenchyma utilizing a neuroendoscope has not been previously reported in the literature. The authors report the case of a 4-year-old patient who presented after a pellet gun injury with a projectile located 6 cm intracranially and lodged within the posterior thalamus and near the posterior limb of the internal capsule. Initial operative repair included repair of a CSF leak with duraplasty, minimal brain debridement, and elevation of a depressed skull fracture. Subsequent CT at 2 months postoperatively revealed migration of the deep intracranial pellet. This finding correlated with intermittent worsening neurological symptoms and signs. A rigid 3-mm neuroendoscope with CT stereotactic navigation was then used to remove the pellet fragment from the thalamus. The patient returned home with alleviation of clinical symptoms and an uneventful postoperative recovery. This case demonstrates that navigation-guided neuroendoscopy can be successfully used to remove projectile fragments from deep brain structures, especially when the migration is along the initial path of the bullet. This technique represents another low-risk curative option in the management of retained bullet fragments in gunshot wound injuries to the head.

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Contributor Notes

Correspondence Willard D. Thompson Jr.: Neurological and Spine Institute of Savannah, GA. dr.thompson@neurosav.com.

INCLUDE WHEN CITING Published online July 10, 2020; DOI: 10.3171/2020.4.PEDS19606.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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