# Surgical Management of an Intracranial Injury Caused by a Handcrafted Arrow in Sub-Saharan Africa: A Global Neurosurgical Relevance

## TL;DR

A 16-year-old boy in Kenya survived a rare intracranial injury from a handcrafted arrow, highlighting the need for neurosurgical care in underserved regions.

## Contribution

This case emphasizes the surgical and antibacterial management of a rare neurotrauma in a resource-limited setting.

## Key findings

- The patient was successfully treated with surgical removal of the arrow and antibiotic prophylaxis.
- The case underscores the importance of neurosurgical missions in Sub-Saharan Africa.
- The patient showed a stable recovery with no major complications post-surgery.

## Abstract

This case report and literature review describe an intracranial injury resulting from a handcrafted arrow that required emergent surgical management in a patient treated at a public hospital in Sub-Saharan Africa. The authors are members of the non-profit organizations Chunilal Initiative and Kisumu Intuitive, which deliver charitable neurosurgical care to the region on a quarterly basis. This unique neurotrauma case, involving a penetrating, contaminated, metallic object, highlights the surgical and antibacterial management of intracranial arrow injuries and emphasizes the importance of neurosurgical missions to underserved regions globally. The patient is a 16-year-old male tribal member with no known or reported comorbidities. He presented with a Glasgow Coma Scale of 15 and imaging consistent with intracranial penetration adjacent to the frontal sinus by a handcrafted Maasai Mara arrow. Due to the barbed nature of the arrow, the frontal bone was drilled to allow for the removal of the arrow. The dura was repaired, and the wound was irrigated without intraoperative or postoperative bleeding complications. The arrow was inoculated with animal feces. Prophylaxis treatment with gentamicin was warranted before the surgery, and an additional three doses were given every eight hours in the next 24 hours. On postoperative day one, periorbital edema was stable, and the neurological exam was grossly intact. The patient was discharged with an uneventful course and prescribed metronidazole for fourteen days. He followed up three weeks later, when the patient had a well-healed incision and an intact neurological exam; however, he did not attend his three-month follow-up. Overall, a teenage boy with an unknown medical history presented to the Jaramogi Oginga Odinga Teaching and Referral Hospital in Kenya, Africa, with a penetrating intracranial injury requiring emergency neurosurgical intervention. The successful management of intracranial arrow injuries in a resource-limited setting highlights the importance of surgical expertise, infection control, and interdisciplinary care in neurotrauma cases. This case highlights the importance of ongoing investment in neurosurgical training, infrastructure, and access to care in underserved regions, such as Sub-Saharan Africa.