Penetrating head and spine injuries due to artisanal Sahelian metal arrows: experience from a tertiary hospital in Niger.

BACKGROUND AND OBJECTIVE: Metal arrows are medieval weapons typically used for hunting and war. The incidence of metal arrow wounds has declined considerably since the 16th century. Different metal arrowheads exist, and the traditional Sahelian arrowhead is barbed. Extraction of this type of metal arrow is challenging because of the risk of extensive damage to surrounding structures. To the best of our knowledge, there are no guidelines in the literature for intracranial and spinal penetrating Sahelian arrow injuries and their surgical extraction. Most authors referred to the principles of common trauma injury. In this study, we aimed to share our experience with the surgical extraction of intracranial and spinal artisanal Sahelian arrows leading to penetrating injuries, and to propose some guidelines for such lesions.

METHODS: We present a consecutive case series of 8 patients admitted to the Department of Neurosurgery of the National Hospital of Zinder for metal arrow injuries of the head and spine between November 2015 and June 2023.

RESULTS: Eight patients with penetrating head and spine barbed-arrow injuries were admitted to our department. Mean age was 19.37 years (range, 15 to 25 years). Patients were all male, from a rural area. Trauma circumstances involved fighting between farmers and herders. All patients received antibiotics, analgesics and tetanus prophylaxis at admission before undergoing surgical extraction under general anesthesia. Successful extraction was achieved in all cases.

CONCLUSION: Extraction of intracranial or spinal artisanal Sahelian arrows is a challenge, particularly in limited facility structures. The proposed guidelines may lead to good extraction outcomes.