Multidisciplinary management of a penetrating cerebellar injury by a fishing speargun: A case study and literature review

BACKGROUND: Fishing spearguns are a rare cause of nonmissile penetrating brain injuries (PBIs). Discussion of their injury patterns and treatments has been published only sporadically. Here, we report a case of a self-inflicted PBI caused by this type of weapon and present an extensive review of previous case reports to help ascertain the appropriate surgical approach. CASE DESCRIPTION: A 26-year-old man with a preexisting psychiatric illness was transferred to our hospital after a self-inflicted shot with a fishing speargun through his mouth. The ensuing injuries included the impalement of a spear intracranially through the soft palate and posterior oropharyngeal wall. The spear was surgically accessed by the otolaryngology team by splitting the soft palate and was removed by the neurosurgery team in the retrograde direction. Cerebral angiographies were done pre- and postoperatively, and these did not detect any vertebrobasilar arterial system injuries. The patient’s postoperative care was uneventful, and he was followed up by a psychiatrist for his long-term care. CONCLUSION: This example of a complicated case of nonmissile PBI caused by an uncommon type of weapon shows how this type of medical emergency can be managed successfully with effective teamwork using a multidisciplinary approach.