Penetrating paediatric traumatic brain injury: lessons from the surgical and medical management of penetrating cranial injuries with wood in rural Kenya

Abstract

BACKGROUND: Penetrating cranial injury with wood is a rare injury that can be difficult to detect and has few treatment guidelines. Cases in rural Africa face limited access to the specialized care required to avoid adverse outcomes. Two pediatric cases emphasize the value of neurosurgical expertise in surgical and medical management of this complex and uncommon injury. OBSERVATIONS: In these cases, the nature and severity of the injuries were missed by family members (case 1) or clinicians (case 2) until several days after the injury. Wood is known to harbor numerous microorganisms due to its porosity, and is considered a contaminated foreign body. Thus, direct inoculation of the cranium by wood and debris led to the delayed formation of abscesses despite prophylactic antimicrobial therapy and extraction of wood fragments in both cases. LESSONS: Penetrating traumatic brain injury from wood requires special attention due to the risk of delayed presentation and recurrent infection despite initial surgical washout and foreign body removal. Surgeons should anticipate the possibility of polymicrobial infection requiring multiple washouts before definitive infection control is achieved and continue monitoring the patient with clinical and imaging follow-up. There is value in exploring specific treatment algorithms with appropriate antimicrobial regimes.