Ha Son Nguyen, Akinwunmi Oni-Orisan, Ninh Doan, Wade Mueller

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Transnasal Penetration of a Ballpoint Pen: Case Report and Review of Literature Ha Son Nguyen, Akinwunmi Oni-Orisan, Ninh Doan, Wade Mueller World Neurosurgery Volume 96, Pages 611.e1-611.e10 (December 2016) DOI: 10.1016/j.wneu.2016.09.021 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 Lateral scout film from CT demonstrating the trajectory of the ballpoint pen. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 Serial axial images of preoperative noncontrast CT of the head. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 3 Serial axial images of preoperative CT angiography demonstrating nonopacification of the right ICA from the mid-petrous segment to the ophthalmic segment. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 4 Pre-embolization DSA. (A and B) Right common carotid artery injection: anterior-posterior (A) and lateral (B) projections demonstrating right ICA injury. (C) Left ICA injection: anterior-posterior projection demonstrating robust collateral reconstitution of the intracranial right ICA circulation through the right posterior communicating artery and anterior communicating artery. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 5 Postembolization DSA. (A and B) Right ICA injection: lateral projections demonstrating lack of flow distal to the carotid bulb and location of coil treatment. (C and D) Left ICA injection: anterior-posterior projections demonstrating persistent collateral reconstitution of the intracranial right internal carotid circulation after coil treatment. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 6 Postoperative CT (A and B), T1-weighted MRI with contrast (C), and T2-weighted MRI FLAIR (D) images. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 7 Postoperative apparent diffusion coefficient and diffusion-weighted MRI sequences demonstrating no significant ischemic stroke. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 8 Postoperative magnetic resonance angiogram of the head confirming persistent reconstitution of collateral circulation through the right carotid circulation. World Neurosurgery 2016 96, 611.e1-611.e10DOI: (10.1016/j.wneu.2016.09.021) Copyright © 2016 Elsevier Inc. Terms and Conditions