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Hitting the Nail on the Head: A Case Report Demonstrating the Importance of a Multidisciplinary Approach to an Unusual Penetrating Intracranial Injury

Thoeny, Allison L. MD*; Hadaya, Iman A. MD*; Lancman, Benn M. MBBS, MHumFac, FANZCA*†; Lew, Vincent MD*†

doi: 10.1213/XAA.0000000000000569
Case Reports: Case Report

A 28-year-old man presented with a penetrating injury by a nail gun to the head. Imaging revealed a nail abutting the superior sagittal sinus without active extravasation. An anesthesia-led multidisciplinary team devised a detailed perioperative plan including conception of a complex decision tree, coordination of care, and resource utilization. In the operating room, the nail was removed under general anesthesia, with blood products and equipment for craniotomy readily available, and imaging modalities reserved for immediate use. This case highlights the importance of a multidisciplinary approach to challenging penetrating head injuries and the crucial role anesthesiologists have as leaders in perioperative care.

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From the *Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; and Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.

Accepted for publication April 10, 2017.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address correspondence to Allison L. Thoeny, MD, University of California, San Francisco, 5177 Diamond Heights Blvd 212, San Francisco, CA 94131. Address e-mail to

© 2017 International Anesthesia Research Society
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