This is an observation of a heavy penetrating fragment mine blast brain wound.A fragment passed through the right and left cerebral hemispheres, caused heavy brain injuries, intracranial hematomas, blast skull base fractures and buttonhole vault fractures, falx and intracranial vessels injuries. The entrance wound was located in the left temporal area, and the exit wound in the right frontal area. The wound tract had signs of a penetrating diametric wound.The penetrating wound manifested itself in the patient’s extremely critical condition, deep coma, and vital functions disorder. The study also revealed combined trunk and extremities injuries.An extended initial surgical brain wound debridement was done, which included brain decompression, wound sanation, skull base and dural reconstruction, and tidal drainage.The patient was transferred to a military hospital with improvements for further rehabilitation treatment. The timely and complete surgical treatment allowed for an effective management of intracranial hypertension and prevented pyoinflammatory complications.