Abstract
Background and importance: Transorbital penetrating brain injury (PBI) due to a non-projectile foreign body is rare. It can lead to life-threatening severe neurovascular damage. Surgery is the primary treatment choice; however, there are a number of approaches that can be considered based on the patient's condition in terms of foreign body location and state of the patient. Clinical presentation: An 18-year-old male carpenter was hit by a log and sustained transorbital PBI while cutting wood with a machine. Computed tomography (CT) scan showed a wooden spike that was approximately 11 cm from the left medial orbital to the superior part of the posterolateral of the petrous bone, crossing the right side at the base of the skull. CT angiography (CTA), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) revealed no internal carotid artery (ICA) and cavernous sinus lesions, respectively. We had a 3D-printed model for preoperative planning, and surgery was performed using a transorbital approach to extract the wood 14 days after the accident. The impacted wood was removed without any complications. Conclusion: There are many surgical approaches for transorbital PBI. We decided to perform the transorbital approach because it is perpendicular to the entry zone. Surgeons should consistently perform minimally invasive procedures based on the clinical and radiological findings.
Highlights
Background and importanceTransorbital penetrating brain injury (PBI) due to a non-projectile foreign body is rare
Prevalence studies have reported that transorbital PBI accounts for 45% and 24% of all traumatic brain injury in children and adults, respectively, and accounts for 0.04% of all traumatic brain injury and 4.5% of all orbital pathologies.[2,3]
Immediate complications include haemorrhage, vascular damage, ischemic brain injury, brain oedema, and cerebral contusion.[5]
Summary
Step 1: Step 2: Step 3: Step 4: Step 5: Step 6: Step 7: Step 8: The patient was placed in the supine position, facing the right side. The operating area around his left eye was disinfected. He was placed perpendicular to the operator's view. The superior and inferior palpebrae were gently retracted using the Langenbeck retractor. Blunt dissection of the left orbital soft tissue was performed. The tip of the wooden foreign body was identified on the medial orbital wall. Osteotomy was performed using Kerrison punch forceps until the hole at the penetration area became wider. The wood was extracted gently using a bone rongeur. Extraction was performed perpendicular to the operator’s view. Haemorrhage was evaluated and treated after extracting the wood. Suturing in layers and canthorrhaphy were performed (Figure 3)
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