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      Surgical treatment of a transorbital penetrating brain injury

      case-report

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          Abstract

          Penetrating injury of the skull and brain are relatively uncommon events, representing about 0.4% of all head injuries. Transorbital penetrating brain injury is an unusual occurrence in emergency practice and presents with controversial management. We report the case of a 10-year-old boy who fell forward on a bamboo stick while playing with other children, causing a penetrating transorbital injury, resulting in meningitis. We performed a combined surgical approach with neurosurgeons and ophthalmogic surgeons. Upon discharge, the patient had a Glasgow Coma Scale score of 15, no motor deficit and no visual loss. We discuss the management of this case and review current literature.

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          Transorbital penetrating injury by a chopstick--case report.

          Y Murao, M Hata, K Okuchi … (2001)
          A one-year-old boy presented with orbitocranial penetrating injury by a chopstick. Neurological examination did not reveal abnormal findings. Skull radiography did not reveal any sign of fracture and there were no abnormal findings. Initially, computed tomography (CT) of the head did not reveal any intracranial lesions. However, bone window CT showed a well-defined low-density abnormality measuring 2.5 cm in length in the right orbit and parasellar region. Magnetic resonance imaging clearly revealed a low-intensity structure extending from the orbit to the prepontine area. Surgical exploration was emergently performed and the wooden fragment was removed. The postoperative course was uneventful. Transorbital penetrating injury by a wooden foreign body is relatively rare. The wound may be superficial and trivial. Major neurological deficit does not usually manifest immediately, so the penetrating injury may be overlooked. If the foreign body is retained in the orbit and cranium, severe infectious complications may occur later.
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            Transorbital orbitocranial penetrating injury due to bicycle brake handle in a child.

            Shail Rupakheti, Satish C. Agrawal, Anand Kumar … (2006)
            Transorbital orbitocranial penetrating injuries (TOPI) are relatively rare and can be caused by a variety of unusual objects. Diagnosis of TOPI should be based on a detailed history and evaluation of available investigations as the penetrating injury may be overlooked. In the present case, a child sustained a penetrating injury with the brake handle of a bicycle due to the accidental fall of the bicycle on him and was managed conservatively. (c) 2007 S. Karger AG, Basel.
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              Management of transorbital brain injury.

              Hung-Lin Lin, Han-Chung Lee, Der-Yang Cho (2007)
              Transorbital brain injuries caused by metal bar penetration are uncommon and often cause serious damage without prompt treatment. Artifacts caused by the penetrating metal bar on computed tomography (CT) often obscure the actual brain damage along the path of penetration, and delayed treatment for the brain insult may result. We present 2 cases of transorbital brain injury following penetration by a metal bar. CT scans were initially performed on both patients. However, image resolution was poor and the extent of brain damage could not be ascertained due to severe artifacts associated with the metal bars. Both patients deteriorated in the emergency room and subsequently received surgical intervention. One patient recovered uneventfully. Unfortunately, the other patient died following surgery due to an unrecognized intracranial hemorrhage with brain herniation. Based on this experience, we recommend prompt surgical decompression with early CT follow-up to determine the true extent of brain damage and assess for possible delayed events inpatients with extended transorbital brain injuries caused by metal bars.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (publisher-id): Clinical Ophthalmology
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove Medical Press
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date (Electronic): 5 October 2010
                Publication date Collection: 2010
                Publication date (Print): 2010
                Volume: 4
                Pages: 1103-1105
                Affiliations
                Division of Neurosurgery, Hospital Das Clinicas University of Sao Paulo Medical School, Sao Paulo, Brazil
                Author notes
                Correspondence: Wellingson Paiva, Teodoro Sampaio Street 498 AP 66, Pinheiros, Zipcode 05406000, Sao Paulo, Brazil, Email wellingsonpaiva@ 123456yahoo.com.br
                Article
                Publisher ID: opth-4-1103
                DOI: 10.2147/OPTH.S9638
                PMC ID: 2952611
                PubMed ID: 20957055
                SO-VID: f05126cc-f054-4466-864a-a33930f702d4
                Copyright © © 2010 Paiva et al, publisher and licensee Dove Medical Press Ltd.
                License:

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: brain trauma,penetrating head trauma,transorbital penetrating brain injury
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: brain trauma, penetrating head trauma, transorbital penetrating brain injury

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