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Siddiqui AR, Kariem K, Fayaz M, Scalia G, Chaurasia B. Transorbital penetrating intracranial injury involving bilateral frontal lobes with evisceration of right eye: A case report. Clin Case Rep 2024; 12:e9018. [PMID: 38827937 PMCID: PMC11142902 DOI: 10.1002/ccr3.9018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
Key Clinical Message Timely diagnosis, multidisciplinary surgical intervention, and appropriate imaging are crucial in managing transorbital-penetrating intracranial injuries (TOPIs), minimizing morbidity, and optimizing patient outcomes. Abstract Transorbital-penetrating intracranial injuries (TOPIs) are rare occurrences with potential for severe neurological complications and high mortality rates. Prompt diagnosis and management are essential to mitigate adverse outcomes. Understanding injury patterns and employing appropriate imaging modalities are crucial for effective surgical planning and patient care. We present a case of a 22-year-old male mechanic who sustained a TOPI involving bilateral frontal lobes with evisceration of the right eye following a workplace accident with a metal cutter. Upon arrival at the emergency department, the patient exhibited vision loss in the right eye, proptosis, and a dilated pupil. Imaging studies revealed the trajectory of a metal arrow through the right orbital roof, necessitating surgical intervention. A multidisciplinary team performed bifrontal craniectomy with duroplasty to remove the foreign body and address associated injuries. Postoperatively, the patient received broad-spectrum antibiotics and anticonvulsants, leading to full recovery and discharge on postoperative day 10. TOPIs present unique challenges due to their rarity and potential for devastating consequences. Our case highlights the importance of timely diagnosis, meticulous surgical planning, and multidisciplinary collaboration in achieving favorable outcomes. Radiological imaging plays a crucial role in guiding treatment decisions and optimizing patient care. This report underscores the significance of early surgical intervention, antimicrobial therapy, and prophylactic measures in reducing morbidity and mortality associated with TOPIs.
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Affiliation(s)
- Abdul Rehman Siddiqui
- Department of NeurosurgerySuper Specialty Hospital GMC, Shireen Bagh SrinagarSrinagarIndia
| | - Kaiser Kariem
- Department of NeurosurgerySuper Specialty Hospital GMC, Shireen Bagh SrinagarSrinagarIndia
| | - Mohsin Fayaz
- Department of NeurosurgerySher‐i‐Kashmir Institute of Medical SciencesSrinagarIndia
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck SurgeryGaribaldi HospitalCataniaItaly
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Takao K, Matsuta H, Murata K, Fujiki M. Reversible cerebral vasospasm and cerebral infarction secondary to meningitis following penetrating head trauma with bamboo. BMJ Case Rep 2023; 16:e254676. [PMID: 37553171 PMCID: PMC10414058 DOI: 10.1136/bcr-2023-254676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
A man in the 70s fell on a bamboo and punctured his left upper eyelid. CT of the head showed fractures of the medial and superior walls of the left orbit, intracranial traumatic subarachnoid haemorrhage, intraventricular haematoma and left frontal cerebral contusion. He was treated conservatively. Despite prophylactic antibiotic therapy, he had prolonged loss of consciousness. A cerebrospinal fluid examination revealed bacterial meningitis. Imaging studies on day 15 showed extensive subacute cerebral infarction in the bilateral parieto-occipital lobes and main trunk artery stenosis. On day 31, MRA showed improvement of the main arteries, and cerebral vasospasm-induced cerebral infarction was diagnosed. He was transferred to rehabilitation with full assistance. The prognosis of bamboo perforation trauma is critical. Thus, preventing and treating central nervous system infection are considered the key to the prognosis. However, given the lack of established treatment for meningitis-associated cerebral vasospasm, case-specific treatment must be considered.
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Affiliation(s)
- Kunpei Takao
- Department of Neurosurgery, Oita University Hospital, Yufu, Oita, Japan
| | - Hiroyuki Matsuta
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Kumi Murata
- Department of Forensic Medicine, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University School of Medicine Graduate School of Medicine, Yufu, Japan
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Breuskin D, Ketter R, Oertel J. Surviving a Self-inflicted Transorbital Pen Intrusion to the Cerebellum: Case Report. J Neurol Surg A Cent Eur Neurosurg 2023; 84:390-393. [PMID: 34781401 DOI: 10.1055/s-0041-1735859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although intracranial traumas by penetrating foreign objects are not absolute rarities, the nature of trauma, the kind of object, and its trajectory make them a one of a kind case every time they occur. Whereas high-velocity traumas mostly result in fatalities, it is the low-velocity traumas that demand an individualized surgical strategy. METHODS We present a case report of a 33-year-old patient who was admitted to our department with a self-inflicted transorbital pen injury to the brain. The authors recall the incident and the technique of the pen removal. RESULTS Large surgical exposure of the pen trajectory was considered too traumatic. Therefore, we opted to remove the pen and have an immediate postoperative computed tomography (CT) scan. Due to its fragility, the pen case could only be removed with a screwdriver, inserted into the case. Post-op CT scan showed a small bleeding in the right peduncular region, which was treated conservatively. The patient was transferred back to intensive care unit and woken up the next day. She lost visual function on her right eye, but suffered from no further neurologic deficit. CONCLUSION Surgical management of removal of intracranial foreign bodies is no routine procedure. Although some would favor a large surgical exposure, we could not think of an approach to do so without maximum surgical efforts. We opted for a minimal surgical procedure with immediate CT scan and achieved an optimal result. We find this case to be worth considering when deciding on a strategy in the future.
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Affiliation(s)
- David Breuskin
- Department of Neurosurgery, Universitätsklinikum des Saarlandes Klinik für Neurochirurgie, Homburg, Saarland, Germany
| | - Ralf Ketter
- Department of Neurosurgery, Universitätsklinikum des Saarlandes Klinik für Neurochirurgie, Homburg, Saarland, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Universitätsklinikum des Saarlandes Klinik für Neurochirurgie, Homburg, Saarland, Germany
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A Rare Case of Orbitocranial Penetrating Injury with Intracranial Wooden Foreign Body Residue. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121832. [PMID: 36557035 PMCID: PMC9783578 DOI: 10.3390/medicina58121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Orbitocranial penetrating injuries (OPIs) caused by wooden foreign bodies (WFBs) are very rare and life threatening. Their diagnosis and treatment could be challenging for an ophthalmologist, requiring us to remain alert for possible intracranial extension. We present a case of a 52-year-old man with a residual wooden foreign body in the left frontal lobe. He had a notable history of trauma from a fall on a tree stump and surgical removal of a wooden foreign body from his left orbit 6 years ago. He was referred to us due to recurrent discharge from the eyelid wound. Wooden foreign body residue was successfully removed with a carefully planned craniotomy without complications. This case describes the clinical manifestation, radiographic features, and treatment of this rare trauma, with an emphasis on imaging diagnosis and multi-disciplinary management.
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Luo M, Wu C, Yang C. Management of Carotid Lacerations with Carotid-Cavernous Fistula Due to Transorbital Penetrating Brainstem Injury by Chopsticks. Neurol India 2022; 70:2188-2191. [PMID: 36352638 DOI: 10.4103/0028-3886.359202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Mingtao Luo
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Chaohua Yang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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A case of death of purulent meningitis caused by transorbital intracranial penetrating injury due to long-term residual bamboo chopstick. Leg Med (Tokyo) 2022; 55:102012. [PMID: 34998200 DOI: 10.1016/j.legalmed.2021.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022]
Abstract
This article reports a case of death caused by purulent meningitis after a long-term transorbital intracranial penetrating injury induced by a bamboo chopstick. A 53-year-old man was pierced with a bamboo chopstick into the left orbit, and the bamboo chopstick broke off. The man remained conscious after the injury but developed paroxysmal headaches. Multiple computed tomography, computed tomography angiography, and rhinoscopy detections revealed that a puncture tract had formed from the left orbit to the right edge of the brainstem through the skull base. However, there was no apparent brain injury or cerebrovascular rupture, thus excluding the possibility of a retained intracranial foreign body by the neurosurgeon. Therefore, the man only received symptomatic and conservative treatments. Unfortunately, the man was found dead one morning, 13 months later. Autopsy and histopathological examinations revealed that he died of purulent meningitis caused by a long-term residual intracranial bamboo chopstick. A review of the relevant literature regarding the diagnosis, including diagnostic values and limitations of different imaging technologies, and treatment of residual intracranial foreign bodies, revealed that this was a case of misdiagnosis, leading to delayed treatment. This case had an indirect causal relationship between the victim's death and medical treatment. This article provides clinical strategies for diagnosing and treating such cases and a forensic perspective for identifying causes of deaths attributed to medical malpractices.
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Hermann A, Lecler A. Post-traumatic retained foreign body in the cavernous sinus. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Penetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol. J Oral Maxillofac Surg 2020; 79:430.e1-430.e12. [PMID: 33068533 DOI: 10.1016/j.joms.2020.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Penetrating facial trauma is an uncommon injury, but patients who present with these dramatic situations require special consideration. We describe the case of a young man who had been shot with an arrow that deeply penetrated his midface as well as report the results of a literature review of penetrating midface injuries. The information gathered was used to create a diagnostic protocol for patients who sustain such injuries. METHODS A PubMed search up to October 2019 using several key phrases was performed, and 623 unique articles were evaluated. Excluding firearm injuries to the midface, there were 57 unique cases that involved penetrating midface injuries. Clinical and imaging data were compiled and evaluated with descriptive statistical analysis. RESULTS The average patient age was 27 years, with a male predilection. The most common reported etiology was accidental trauma (54%), and a knife was the most common weapon of injury (30%). The most common (32%) specific location of trauma was within the orbital region, including the canthus or the eyelid. In all cases where the patient had not died immediately, surgery was used to remove the penetrating object. We found that computed tomography was the most commonly obtained imaging study (39% of cases). Radiographs were the sole imaging in 28% of the cases, with angiography (16%) and magnetic resonance imaging (10%) used less frequently in management. In 28% of the cases, deep structures, such as the carotid artery, sphenoid sinus, or skull base, were involved in the injury. In 25% of the cases, there was injury to the central nervous system. Death occurred in 8.8% of the cases. Postoperative complications occurred in at least 21% of the cases. Statistical analysis also revealed a significant correlation between antibiotic use and full recovery. Penetration of the object posterior to the maxillary sinus was correlated with incomplete recovery or death. CONCLUSIONS Based on all case reports collected, a Dartmouth Penetrating Midface Protocol was developed to aid the practitioner who may happen to be responsible for these dramatic life-threatening injuries. The Dartmouth Penetrating Midface Protocol is based on the type of imaging available at the treating facility, the neurologic and hemodynamic stability of the patient, and the depth of penetration beyond the posterior wall of the maxillary sinus.
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Xu L, Xu F, Li L, Liu W, Kit Leung GK, Liu B. The Surgical Strategies and Techniques of Transorbital Nonmissile Brain Injury. World Neurosurg 2020; 144:e856-e865. [PMID: 32971278 DOI: 10.1016/j.wneu.2020.09.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to summarize the experience with the management of transorbital brain injury (TOBI) at our institution that may help inform surgical decision-making. METHODS Four adults with TOBIs were admitted to our hospital and received surgical treatment. The patients' clinical manifestations, physical findings, imaging data, surgical treatment, and postoperative outcome were prospectively collected and subject to retrospective analysis. RESULTS All patients were male. In 2 patients, the entry point of the cranium was the superior orbital fissure, whereas in the other 2, the entry point was the orbital roof. Thorough physical examination and comprehensive diagnostic imaging were performed preoperatively in all patients for careful assessment of the foreign body and its surrounding important structures. In collaboration with our multidisciplinary trauma team, individualized surgeries were successfully designed and performed in the 4 patients to remove the foreign bodies along the path of their trajectories. Three patients had uneventful postoperative courses, whereas 1 patient died because of severe cerebral ischemia and refractory brain swelling after decompressive craniectomy. CONCLUSIONS A comprehensive understanding of the regional anatomy of the trajectory is the cornerstone for surgical management of TOBIs. Adequate preoperative imaging examinations are essential for the evaluation of surgical risks and for making a tailored management strategy. Early surgical exploration through multidisciplinary collaboration is highly recommended for achieving a favorable outcome.
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Affiliation(s)
- Long Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, P.R. China
| | - Feifan Xu
- Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China
| | - Liang Li
- Department of Neurosurgery, Peking University First Hospital, Beijing, P.R. China
| | - Weiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, P.R. China
| | - Gilberto Ka Kit Leung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, P.R. China
| | - Baiyun Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, P.R. China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, P.R. China.
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Transorbital-penetrating intracranial injury due to a homemade metal arrow: A case report. Ann Med Surg (Lond) 2020; 57:183-189. [PMID: 32774851 PMCID: PMC7398978 DOI: 10.1016/j.amsu.2020.07.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 07/18/2020] [Indexed: 11/21/2022] Open
Abstract
A transorbital-penetrating intracranial injury (TOPI) is an unusual traumatic brain injury. This rare injury has the potential to result in serious and fatal brain damage with a high mortality rate and requires prompt multidisciplinary surgical intervention. Here, we describe an interesting case in which a patient who presented with accidental penetrating injuries of the brain was found to have a transorbital-penetrating intracranial injury (TOPI). We chose an anterior approach to the foreign body above the entrance wound for removal in a retrograde manner with fluoroscopic guidance. The patient remained well with no complications and was discharged on postoperative day 10. Reasonable diagnostic imaging, surgical planning, and careful post-surgery management can increase patients successful outcomes. A transorbital-penetrating intracranial injury (TOPI) is an uncommon traumatic brain injury. TOPIs have the potential to result in serious brain damage with a high mortality rate. An interesting case of accidental TOPI that was treated successfully with fluoroscopic guidance is presented.
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11
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Ren Y, You C. Management strategy of a transorbital penetrating injury by a wooden stick. Neurol India 2020; 68:509-511. [PMID: 32415036 DOI: 10.4103/0028-3886.284364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
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12
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Huang T, Ling J, Liu M, Qiu C, Ding G, Huang J, Krischek B, Yang S, Zheng F. Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report. J Int Med Res 2019; 48:300060519886210. [PMID: 31840553 PMCID: PMC7607224 DOI: 10.1177/0300060519886210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A transorbital penetrating injury by a foreign body is an extremely rare type of injury,
and its severity is often difficult to estimate by examination of the superficial wound
alone. Thus, such injuries are challenging for neurosurgeons to investigate and manage. We
herein present a peculiar case involving a 3-year-old girl with a penetrating transorbital
skull-base injury caused by a coloring pencil and discuss the anatomical location of the
foreign body, radiological examination findings, diagnosis, and treatment strategy. The
pencil was completely removed by manual extraction. Follow-up investigations confirmed a
good outcome. Multidisciplinary cooperation, radiological examination, correct diagnosis,
timely treatment, and detailed follow-up studies are necessary to manage penetrating
transorbital skull-base injuries caused by foreign bodies. The orbital walls are very thin
in children, and the orbital roof and superior orbital fissure are often penetrated by
foreign bodies in cases such as that described herein. The anatomical location of the
foreign body influences the clinical management strategy.
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Affiliation(s)
| | - Jun Ling
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Ming Liu
- Gannan Medical University, Jiangxi, China
| | - Chuanzhen Qiu
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Guanfu Ding
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Jun Huang
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Boris Krischek
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Shaochun Yang
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Feng Zheng
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China.,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China
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MacLean MA, Mukhida K, Shankar JJS, Schmidt MH, Clarke DB. Complete recovery following transorbital penetrating head injury traversing the brainstem: case report. J Neurosurg Pediatr 2019; 24:697-701. [PMID: 31491753 DOI: 10.3171/2019.6.peds19106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
Transorbital penetration accounts for one-quarter of the penetrating head injuries (PHIs) in adults and half of those in children. Injuries that traverse (with complete penetration of) the brainstem are often fatal, with survivors rarely seen in clinical practice. Here, the authors describe the case of a 16-year-old male who suffered and recovered from an accidental transorbital PHI traversing the brainstem-the first case of complete neurological recovery following such injury. Neuroimaging captured the trajectory of the initial injury. A delayed-onset carotid cavernous fistula and the subsequent development of internal carotid artery pseudoaneurysms were managed by endovascular embolization.The authors also review the relevant literature. Sixteen cases of imaging-confirmed PHI traversing the brainstem have been reported, 14 involving the pons and 12 penetrating via the transorbital route. Management and outcome of PHI are informed by object velocity, material, entry point, trajectory, relationship to neurovascular structures, and the presence of a retained foreign body. Trauma resuscitation is followed by a careful neurological examination and appropriate neuroimaging. Ophthalmological examination is performed if transorbital penetration is suspected, as injuries may be occult; the potential for neurovascular complications highlights the value of angiography. The featured case shows that complete recovery is possible following injury that traverses the brainstem.
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Affiliation(s)
- Mark A MacLean
- 1Dalhousie University, Division of Neurosurgery, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Karim Mukhida
- 2Dalhousie University, Department of Anesthesia, Pain Management & Perioperative Medicine, Halifax, Nova Scotia
| | - Jai J S Shankar
- 3Department of Medicine, Department of Radiology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba; and
| | - Matthias H Schmidt
- 4Dalhousie University, Division of Diagnostic Radiology, Department of Diagnostic Radiology, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - David B Clarke
- 1Dalhousie University, Division of Neurosurgery, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia
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Del Verme J, Giordan E, Marton E, Zanata R, Di Paola F, Canova G, Longatti P. Classification of orbitocranial wooden foreign body penetration injuries: what to do when they violate the intracranial space? A systematic review. J Neurosurg Sci 2019; 64:190-199. [PMID: 31738026 DOI: 10.23736/s0390-5616.19.04793-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Orbitocranial wooden foreign body (OWF) penetrations are rare but challenging occurrences that may violate the intracranial space resulting in brain damage and hemorrhagic, as well as infectious, complications. Moreover, there is a specific subset of cases of OWF penetrations that are particularly challenging to treat. Although there are well-defined management guidelines for pure intraorbital localization, there is not yet a defined treatment protocol for foreign bodies reaching the intracranial space. However, their removal performed either directly or through craniotomy, is often easily attainable given the condition that all necessary precautions are accounted for. EVIDENCE ACQUISITION After having treated a 48-year-old man with a transorbital OWF penetration injury at our neurosurgical department, we systematically reviewed the last 15 years of literature to define and summarize the best management strategy. Multiple databases were searched for case reports and case series involving patients with intraorbital and transorbital OWF penetration injuries. For each study, we extracted data on age, sex, imaging modality, type of wood (processed vs. unprocessed), location of periorbital and intracranial entry site, treatment type ("pull and see" or "open and see"), antibiotic therapy, and complications. EVIDENCE SYNTHESIS We classified transorbital OWFs into two categories: transorbital with only cavernous sinus involvement and transorbital with more extensive intracranial involvement. We described what we believed was the most appropriate management conduct in each case. CONCLUSIONS Grounded on our experience and on the review of the literature, we suggest, based on the anatomical localization of the OWF, a classification system for OWFs which is coupled with a tailored treatment strategy for each case. These suggestions are made to provide surgeons with direction on the correct management of such rare but challenging occurrences.
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Affiliation(s)
- Jacopo Del Verme
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy -
| | | | - Roberto Zanata
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | | | - Giuseppe Canova
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
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Narusawa H, Koizumi K, Sano F, Yagasaki H, Nakane T. Penetrating craniocerebral injury by chopsticks in a Japanese boy confirmed by combined brain computed tomography and magnetic resonance imaging. Pediatr Neonatol 2019; 60:461-462. [PMID: 30833233 DOI: 10.1016/j.pedneo.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/02/2018] [Accepted: 02/12/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Hiromune Narusawa
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan.
| | - Keiichi Koizumi
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Fumikazu Sano
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hideaki Yagasaki
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Takaya Nakane
- Department of Pediatrics, Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan
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Yoshihara S, Baba S, Kanemaru A, Ichikawa T. Craniofacial penetration by a wooden stick. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:393-395. [PMID: 30878510 DOI: 10.1016/j.anorl.2018.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Penetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity. CASE SUMMARY We describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain. DISCUSSION Penetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.
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Affiliation(s)
- S Yoshihara
- Department of Otorhinolaryngology - Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Otolaryngology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-City, Tokyo 183-8561, Japan.
| | - S Baba
- Department of Otorhinolaryngology - Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Otolaryngology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-City, Tokyo 183-8561, Japan
| | - A Kanemaru
- Department of Otorhinolaryngology - Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Otolaryngology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-City, Tokyo 183-8561, Japan
| | - T Ichikawa
- Dolphin west-Funabashi ENT clinic, 2-335-1 Katsushika, Funabashi-City, Chiba 273-0032, Japan
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Retained Eyeglasses in the Orbital Cavity After Penetrating Facial Trauma. J Craniofac Surg 2018; 29:e679-e680. [PMID: 30106813 DOI: 10.1097/scs.0000000000004854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study describes a 68-year-old man who was presented to the emergency department with left orbital cavity penetration by his eyeglasses. The eyeglasses had entered the orbit and at presentation his eyesight could not be measured. The foreign body was extracted carefully and panfacial bone fractures were then reduced through lateral rhinotomy combined with a lip-splitting incision. When planning removal of an unusual foreign body from the orbital cavity, care should be taken not to injure the optic nerve, periorbital musculatures, or the eyeball.
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Nussbaum ES, Graupman P, Goddard JK, Kallmes KM. Air gun orbitocranial penetrating injury: emergency endovascular treatment and surgical bypass following pellet migration to middle cerebral artery: case report. J Neurosurg Pediatr 2018; 21:270-277. [PMID: 29271732 DOI: 10.3171/2017.8.peds17320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a 14-year-old boy presenting with an orbitocranial penetrating injury (OPI) from a metallic air gun pellet to the left eye who developed hemiparesis and speech difficulty due to migration of the pellet to the left middle cerebral artery. They highlight the potential complications associated with both OPIs and intravascular foreign body migration and occlusion by describing the patient's presentation, results of imaging evaluation, and the combined endovascular treatment and extracranial-intracranial bypass, which resulted in rapid restoration of blood flow and full neurological recovery with intact vision. Based on this case and a review of the literature on intracranial foreign body migration with resultant vascular occlusion, the authors recommend that complex OPIs be treated at centers that offer both neuroendovascular and neurovascular surgical capabilities on an urgent basis to manage both the primary injury and potential secondary vascular compromise.
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Affiliation(s)
- Eric S Nussbaum
- 1National Brain Aneurysm Center, Department of Neurosurgery, United Hospital
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Transoral Intracranial Injury via Middle Skull Base by a Blunt Chopstick in a Child. World Neurosurg 2017; 103:952.e11-952.e17. [DOI: 10.1016/j.wneu.2017.04.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/17/2022]
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