[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-440271-105":59,"doc-detail-440271-en":129},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":122,"head_meta":124,"extra_data":126,"updated_unix":128},105,"en","posterior-fossa-penetrating-traumatic-brain-injury-from-military-blast-case-lessons","Posterior fossa penetrating traumatic brain injury from military blast - Case Lessons","","Posterior fossa penetrating traumatic brain injury (pTBI) in military combat is rare yet carries substantial neurovascular risk. An illustrative case describes a 51-year-old male mine explosion patient in Ukraine, with a 4 × 1.5–cm metal fragment traversing the skull base into the posterior cranial fossa adjacent to vertebral artery and sigmoid sinus. Digital subtraction angiography guided a right retrosigmoid craniotomy for atraumatic foreign body removal, facilitated by CSF release for visualization while minimizing retraction injury. Early angiography and meticulous microsurgical technique are emphasized.",{"@graph":69,"@context":121},[70,84,104],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/posterior-fossa-penetrating-traumatic-brain-injury-from-military-blast-case-lessons/440271/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":98,"encodingFormat":97,"isAccessibleForFree":99,"interactionStatistic":100},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/posterior-fossa-penetrating-traumatic-brain-injury-from-military-blast-case-lessons/440271.png","ImageObject",300,407,{"name":92,"@type":93},"Blue Pony","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-29",true,{"@type":101,"interactionType":102,"userInteractionCount":8},"InteractionCounter",{"@type":103},"ViewAction",{"@type":105,"mainEntity":106},"FAQPage",[107,113,117],{"name":108,"@type":109,"acceptedAnswer":110},"What makes posterior fossa penetrating traumatic brain injury in military settings especially risky?","Question",{"text":111,"@type":112},"It is rare but involves high neurovascular risk, particularly when fragments lie near critical vessels and cranial nerve structures in the posterior cranial fossa.","Answer",{"name":114,"@type":109,"acceptedAnswer":115},"How was vascular injury evaluated before surgery in the case?",{"text":116,"@type":112},"Digital subtraction angiography on admission showed a patent right vertebral artery, an occluded transverse-sigmoid sinus, and partial internal jugular vein occlusion.",{"name":118,"@type":109,"acceptedAnswer":119},"What surgical strategy helped enable safe foreign body removal?",{"text":120,"@type":112},"A right retrosigmoid craniotomy with CSF release from the cerebellomedullary cisterns improved visualization and reduced retraction injury risk, supporting atraumatic fragment removal and closure using a vascularized pericranial graft.","https://schema.org",{"og:url":83,"og:type":123,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":125,"canonical":83},"index,follow",{"doc_id":127,"site_id":62},440271,1790716867,{"code":4,"msg":5,"data":130},{"doc_id":127,"user_id":131,"nickname":92,"user_avatar":132,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":133,"file_id":134,"file_url":135,"file_type":136,"file_size":137,"view_count":8,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":138,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":139,"faqs":140,"seo_title":141,"seo_description":67,"update_tm":142,"read_time":143},962090760266,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","JOURNAL OF NEUROSURGERY:  \nCase Lessons  \nJ Neurosurg Case Lessons 11(1): CASE25563, 2026  \nDOI: 10.3171/CASE25563  \nPosterior fossa penetrating traumatic brain injury from military blast: illustrative case  \nJeffrey M. Breton, MD,1 Stefan T. Prvulovic, BS,2 Cameron J. Sabet, MS, MBA, MA,2 Bohdan Sirko, MD,3 Rostyslav Malyi, MD,3 Vadym Perepelytsia, MD, PhD,4 Rocco A. Armonda, MD,1 and Andrii Sirko, MD, PhD3  \n1Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC; 2Georgetown University School of Medicine, Washington, DC; 3Center for Cerebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine; and 4Endovascular Center, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine  \nBACKGROUND Posterior fossa penetrating traumatic brain injury (pTBI) in military combat is rare but carries high neurovascular risk. OBSERVATIONS A 51-year-old male sustained a mine explosion injury in Ukraine, in which a 4 × 1.5–cm metal fragment penetrated through the skull base into the posterior cranial fossa. The fragment was adjacent to the vertebral artery, sigmoid sinus, lower cranial nerves, and occipital condyle. Digital subtraction angiography was completed on arrival, which showed a patent right vertebral artery, occluded transverse-sigmoid sinus, and partial internal jugular vein occlusion. The patient underwent a right retrosigmoid craniotomy for foreign body removal and debridement. CSF release from the cerebellomedullary cisterns facilitated visualization while reducing retraction injury risk. The fragment was removed atraumatically and a vascularized pericranial graft was used for closure.  \nLESSONS Military posterior fossa pTBI presents unique challenges related to blast mechanisms. Effective management requires early angiography for suspicion of vascular injury and meticulous microsurgical technique, even in resource-constrained environments where a one-stage, comprehensive approach to treatment may be valuable.  \n[https://thejns.org/doi/abs/10.3171/CASE25563](https://thejns.org/doi/abs/10.3171/CASE25563)  \nKEYWORDS penetrating trauma; posterior fossa; brain injury; war; microsurgery; case report  \nPenetrating traumatic brain injury (pTBI), although rare, may occur during military combat. While numerous studies and scoring tools have advanced our understanding of pTBI, the majority of our current understanding originates from experience in civilian settings and focuses predominantly on gunshot wounds to the head.1–15 Studies on military pTBI generally have not proposed novel classification or scoring schemes.16–18 Importantly, pTBI in modern warfare is most frequently caused by shrapnel from artillery and other explosives, not bullets. Aerial drone attacks are one such example. Penetrating injuries in conjunction with blast trauma carry a high risk for cavitation, vessel wall trauma, and delayed hemorrhage or infectious complications, especially in posterior fossa injuries.19  \nThe utility of civilian-derived pTBI classification scales in such injuries is unclear. Penetrating injuries of the posterior fossa represent an understudied type of pTBI. A small number of such cases are sometimes included in reports describing patients with all types of pTBI. To the best of our knowledge, few prior reports have focused exclusively on patients with pTBI of the posterior fossa.20 Recently, Sirko et al. introduced the STOPWAR (Surgical Treatment of Penetrating Wounds After Resuscitation) classification, the first system developed  \nspecifically for posterior fossa penetrating injuries, showing strong predictive performance for 1-month mortality (area under the curve [AUC] 0.93) and functional outcome (AUC 0.84), based solely on projectile trajectory.21  \nIllustrative Case  \nA 51-year-old male soldier sustained injuries from a mine explosion in Ukraine while in combat, and a 4 × 1.5–cm metal fragment pierced the skull base and entered the posterior cranial fossa (Video 1) . ","cbCaiojeoSaFej1b","https://ap.wps.com/l/cbCaiojeoSaFej1b","pdf",1315849,"English","# Case Lessons\n## Background\n## Observations\n## Lessons\n## Illustrative Case\n## Abbreviations and Publication Details","[{\"question\":\"What makes posterior fossa penetrating traumatic brain injury in military settings especially risky?\",\"answer\":\"It is rare but involves high neurovascular risk, particularly when fragments lie near critical vessels and cranial nerve structures in the posterior cranial fossa.\"},{\"question\":\"How was vascular injury evaluated before surgery in the case?\",\"answer\":\"Digital subtraction angiography on admission showed a patent right vertebral artery, an occluded transverse-sigmoid sinus, and partial internal jugular vein occlusion.\"},{\"question\":\"What surgical strategy helped enable safe foreign body removal?\",\"answer\":\"A right retrosigmoid craniotomy with CSF release from the cerebellomedullary cisterns improved visualization and reduced retraction injury risk, supporting atraumatic fragment removal and closure using a vascularized pericranial graft.\"}]","Posterior fossa penetrating traumatic brain injury from military blast - Case Lessons | PDF",1790691685,13]