Table 1.

Cases involving intracranial injury caused by radiologically confirmed acupuncture needle migration

	Abumi et al4 (1996)	Hama et al5 (2004)	Miyamoto et al6 (2010)	Fukaya et al7 (2011)	El-Wahsh et al8 (2018)	Current case
Age (years)/sex	60/F	70/M	47/M	44/M	NA/M	55/F
Acupuncture point	Posterior neck	Posterior neck	Posterior neck	Posterior neck	Posterior neck	Posterior neck
Further needle migration	No	No	Yes	No	Yes	No
Access	Atlanto-occipital junction	Atlanto-axial junction	Atlanto-occipital junction	Atlanto-occipital junction	Atlanto-occipital junction	Atlanto-occipital junction
Needle location	Intradural	Intradural	Intradural	Intra- and extradural	Intra- and extradural	Intra- and extradural
Needle direction	Left posterolateral to right anterolateral	Left posterolateral to right anterolateral	Left posterolateral to right anterolateral	Midline	Midline	Right posterolateral to left anterolateral
Injury site	Medulla oblongata	Cervical spinal cord / medulla oblongata	Cerebellar tonsil / medulla oblongata	Medulla oblongata	Medulla oblongata	VA
Intracranial hemorrhage	None	None	Small subpial hemorrhage	Small subpial hemorrhage	None	None
Ischemic stroke	None	NA	None	None	None	None
Symptoms	Motor and sensory disturbances in the right upper extremitya	Left facial paresthesiab	Discomfort in the posterior neck	Pain in the left face / lower extremity and dysesthesia in the left lower extremity	None	None
Removal surgery	Yes	No	Yes	Yes	Yes	Yes
Surgery-related complication	No	NA	No	No	No	CSF leakagec
Outcome	Recovered	Deteriorated	Recovered	Improved	Without neurological deficits	Without neurological deficits

CSF: cerebrospinal fluid

F: female

M: male

NA: not applicable or not available

VA: vertebral artery

^aThese symptoms developed 18 years after acupuncture treatment.

^bThe symptom appeared 1 year after the needle penetrated the cervical spinal cord and medulla oblongata.

^cSurgical repair was required for postoperative CSF leakage.