we present a case of intracranial taser ( thomas a. swift s electric rifle , taser international , scottsdale , arizona ) dart penetration requiring neurosurgical management .
we review the literature of three cases and determine optimum management of patients with direct intracranial taser injuries .
our case is of a fourteen - year - old female who was running away from police and was subsequently shot in her right parietal skull with a taser .
she had initially presented to a small community hospital but was transferred subsequently to our neurosurgical unit .
she complained of a moderate right parietal headache . on neurological exam , she had no deficits .
she clearly had a taser dart in the right posterior parietal skull with 4 cm of the dart visible outside of her skull ( figure 1 ) .
taser dart extracranial portion with cautery wire noted ct scan of the head revealed the dart to have traversed the inner and outer tables of the skull , with a portion extending intracranially ( figure 2 ) .
ct head bone windows showing penetration through inner and outer tables of skull intracranially no hemorrhage was noted . the transverse sinus was not involved .
multiple attempts were made at removing the taser dart under sterile conditions at bedside with the dart subsequently breaking , leaving only the intracranial component ( figure 3 ) .
after attempt at removing dart at bedside in patient two , extracranial portion broke off patient was taken to the operating room and a craniectomy was performed for removal of the dart .
it was noted that the dart traversed the entire skull leaving a small hole and was tightly adherent to the skull ( figure 4 )
. the outer layer of dura was penetrated and had a blue discoloration likely from heating , however no csf leak was noted .
taser devices were developed in 1974 and are energy weapons that temporarily stun a person by affecting neurotransmitter transmission .
newer tasers have been developed since and can operate at 14 watts and deliver peak voltages of up to 50,000 volts . after the initial blast , the voltages then decrease .
taser mechanism of action is via compressed nitrogen propelling two barbed probes up to 15 feet ( 1 ) .
electrical impulses are transmitted between the two probes and once striking an individual , they lose complete neural control ( 2 ) .
there are only now three documented direct intracranial injuries due to taser penetration of skull , two from our department ( 3 ) and one from university of kansas ( 2 ) . in all three cases of penetration of skull , attempts at removing the device at bedside were unsuccessful due to the complete penetration of both inner and outer tables of the skull ( 2 ) .
the goal is to remove the device entirely , in a timely fashion to diminish risk of infection , and without any associated intracranial bleeding . in the two cases at university of new mexico ( 3 ) ,
both patients required small surgical craniectomies for removal of skull and taser fragment . only one patient had direct dural penetration .
these devices are so embedded in the skull that attempts at removing these at bedside have not been successful .
the one case at university of kansas ( 2 ) did not penetrate the inner table of the skull .
ct scan demonstrated a small fragment just superficial to the inner table of the skull and the decision was made to leave the fragment in .
in all three documented cases , there was no intracranial bleeding or neurological compromise post - operatively .
based on the existing literature , if the fragment does not penetrate the inner table of the skull , we propose that the fragment may be left in place and closure of laceration on skin performed . if the dart penetrates the entire skull and possibly the parenchyma , it acts as a sharp object that may be a focus for cortical contusion and therefore should be removed via small craniectomy .
it may also act as a source of infection and so neurosurgical consultation for removal of fragment would thus be recommended due to multiple risk factors .
 we report the case of a fourteen - year - old female who obtained taser dart penetration to her right parietal region . 
 she was neurologically intact with headache . 
 ct scan of the head demonstrated taser penetration intracranially without hemorrhage . 
 attempts were made at sterile removal of taser at bedside under sedation . 
 this caused the taser to break at multiple points leaving only an intracranial component . 
 she was urgently taken to the operating room for craniectomy for taser removal . after reviewing the literature of an additional two patients , we suggest patients should not have attempts at removing device at bedside and 
 should be taken to the operating room for adequate removal and washout . 
INTRODUCTION
CASE REPORT
DISCUSSION