[3D-CT highly useful in diagnosing foreign bodies in the paraesophageal orifice]

Excellent recovery after nonmissile penetrating traumatic brain injury in a child: A case report

Background:

Nonmissile penetrating traumatic brain injuries (pTBIs) are low-velocity injuries which can be caused by a variety of inflicting tools and represent a rare entity in children. Poor outcome has been attributed with an initial admission Glasgow Coma Scale (GCS) of <5, asymmetrical pupil size, and specific initial computed tomography scan findings including brainstem injury.

Case Description:

We report a case of an 11-year-old boy who presented to our ER with a GCS of 6 after being assaulted on his head by a 30 cm length metallic tent hook penetrating his forehead reaching down to the central skull base zone.

Conclusion:

We demonstrated that following standard recommendations in the management of pTBI which include applying the advanced trauma life support protocol in ER, acquiring the needed preoperative neuroimaging studies, avoiding moving the penetrating object till patient shifted to OR, and finally performing a planned stepwise surgical intervention through craniotomy may yield an excellent functional recovery, especially in children despite an otherwise grave initial presentation and apparently profound brain injury.

Nonmissile Penetrating Head Injuries: Surgical Management and Review of the Literature

BACKGROUND

Nonmissile penetrating head injuries (NPHIs) in the civilian population are rare but potentially fatal. Although numerous cases have been reported in the literature, the surgical management of such injuries is still ambiguous, especially with development of surgical techniques. Here, we report 5 cases of NPHIs managed with different surgical techniques and review the literature on surgical treatment of these injuries to outline the appropriate management for these patients from a neurosurgical perspective.

METHODS

We retrospectively reviewed 5 cases of NPHIs managed surgically in our department. The clinical data were collected, including cause, type of objects, way of penetration, initial clinical evaluation, imaging, surgical intervention, postoperative care, complication, follow-up, and outcome. In addition, a systematic review of the literature was performed in the PubMed database to search for articles on surgical treatment of these injuries.

RESULTS

These 5 cases were caused by twisted steel bar, electric welding rod, and sewing needle, respectively. Preoperative imaging, including computed tomography, magnetic resonance imaging, and digital subtraction angiography, was selectively performed to assist the operative plan. Foreign objects were removed surgically in all cases. Postoperative prophylactic administration of antibiotics and anticonvulsants was used to prevent infectious and epileptic complications. Most of the patients achieved a better outcome except for one.

CONCLUSIONS

NPHIs can be fatal but they can be managed with satisfactory results by proper preoperative imaging evaluation, rapid appropriate surgical management, and accurate postoperative care. Personalized surgical intervention should be undertaken depending on the mechanism and extent of the NPHI.

3D computer-assisted assessment of complicated penetrating foreign bodies cases in ENT practice

A retrospective research was performed in order to evaluate three-dimensional (3D) computer-assisted detection of penetrating foreign bodies (FB) in the ENT practice in order to assess its usefulness and to specify its application. FBs in the head and neck were detected using 3D CT imaging in order to assess the usefulness of 3D images in the ENT operative practice. Three blinded surgeons were involved in comparison between plain and 3D CT images in order to assess 3D usefulness for precise formulation of a surgical plan. The observed relationship of the FBs to anatomical structures of the ethmoidal sinuses, eye orbit, and neck tissues was found instrumental for surgeon's decision making in planning the approach to operative removal of the FB. It helps to understand the relationships between a FB and surrounding anatomical structures better then the plain X-rays or CT-scan. There was no significant difference in cost between plain CT and 3D images. 3D computer-assisted detection of FBs increase our diagnostic abilities and appears to be a valuable addition to our diagnostic technique. Its main importance, however, lies in its capacity to help a surgeon plan an operation much more carefully avoiding improvisation during the operation itself.