＜Editors' Choice＞ Surgical Removal of an Intracranially Migrated Acupuncture Needle: a Case Report and Literature Review

Acupuncture is a popular alternative therapy worldwide and is generally safe. However, serious acupuncture-related complications can occur. Intracranial complications caused by a migrated acupuncture needle are extremely rare. Herein we report a surgical case of intracranial acupuncture needle migration and discuss the key technical aspects of the procedure. We additionally performed a review of the relevant literature. A 55-year-old woman presented with migration of a broken acupuncture needle via the posterior cervical skin. Computed tomography (CT) showed that the needle migrated intra- and extradurally via the atlanto-occipital junction. CT angiography revealed that the needle tail was located adjacent to the right distal horizontal loop of the vertebral artery. Meanwhile, the needle tip was positioned in the premedullary cistern adjacent to the medulla oblongata via the right lateral medullary cistern. Emergent surgical removal was conducted. Intradural exploration was required as the needle was not found in the epidural space. The needle penetrated the adventitia of the right intradural vertebral artery. We failed to pull out the needle toward the epidural space. After the needle was completely pulled into the intradural space, it was successfully removed without bleeding complication. Postoperative CT showed no evidence of residual needle fragment. The patient was discharged home without any sequelae. To the best of our knowledge, this is the first case of penetrating vertebral artery injury caused by radiologically confirmed acupuncture needle migration. An intracranially migrated needle should be removed urgently to prevent further migration causing brainstem, cranial nerve, and vessel injuries. The surgical strategy should be selected according to needle location and direction.