Transorbital Penetrating Research Articles

Early removal of transorbital penetrating traumatic brain injury by a wooden object: a case report

Introduction and Importance: Transorbital penetrating traumatic brain injury (TPTBI) is a rare cause of penetrating head injury, yet the diagnoses can be overlooked in some cases due to incomplete history, trivial trauma, and the absence of immediate neurologic deficits. Case Presentation: A 4-year-old male child was admitted with a diagnosis of TPTBI by a wooden object. Non-contrast enhanced CT scan revealed a linear hypodense structure extending from the superior wall of the right orbit into the frontal lobe with displaced fragments into the brain. Additionally, cerebral contusion, pneumocephalus, and hematoma with surrounding edema were seen in the frontal lobe. Early extraction of the foreign body was performed by a multidisciplinary team of Neurosurgeons and Ophthalmologists. The wooden fragment of size 10 cm×1 cm×1 cm was removed by a small mini-craniotomy of the right frontal supraorbital bone with the gentle pulling of it through the dura mater and frontal cortex. The postoperative course was uncomplicated, vision was restored, and there were no neurologic deficits at the time of discharge on the 7th postoperative day with good postoperative outcomes. Clinical Discussion: Delayed removal of TPTBI may be complicated by misidentification of entry points, extensive scarring around the foreign body, adherence to the intracranial vessels, and increasing mortality due to infectious complications. Therefore, early exploration with the help of a multidisciplinary team will most likely result in successful debridement, good neurologic outcomes, and lower morbidity and mortality. Conclusion: Accurate diagnosis and early intervention for TPTBI may prevent possible infectious and neurologic complications.

Minor Traumas with Major Consequences: Penetrating Transorbital Injuries with Sharp Objects

Transorbital penetrating injuries are rare but can cause severe life-threatening intracranial injuries to the brain, brainstem, or internal carotid artery. They often present dramatically with an obvious trauma and extensive collateral damage to surrounding structures [1]. However, some injuries are subtle, with a seemingly trivial trauma and little or no obvious damage to the surrounding tissues. These innocuous injuries carry the risk of being overlooked and the extent of the injury not being recognized. Very rarely are isolated third and sixth nerve palsies caused by penetrating trauma [2], [3]. We present two rare cases of penetrating transorbital traumas leading to third and sixth nerve palsies.

Transorbital penetrating head injury with a favorable outcome: illustrative case

Transorbital penetrating head injuries (PHIs) are uncommon but can lead to substantial deficits, depending on intracranial involvement and the neuroanatomical structures affected. Complete recovery after such injuries is rare. A 7-year-old boy sustained a PHI when he fell onto a garden spike while climbing a fence. Initial imaging showed an orbital roof fracture, focal subarachnoid hemorrhage, and an intraparenchymal hemorrhage in the right frontal lobe with associated linear tract extending to the contralateral superior temporal gyrus. Relevant neuroanatomical structures, including the anterior cerebral arteries (ACAs) and the basal ganglia, were spared. This is in keeping with superior transorbital PHI caused by a garden spike, which had transgressed the skull entering from the right superior orbit. Clinically, he experienced some transient right-sided weakness and mild speech disturbance. Some questionable vasospasm of the ACAs observed on interim magnetic resonance imaging was absent in a repeat imaging study, followed by an unremarkable radiographic follow-up at 6 months after injury. At 18 months after injury, he is neurologically intact without deficit. Most PHIs bear serious lifelong consequences, but here was a case of a deep, penetrating object that managed to avoid all significant neuroanatomical pathways, leading to complete recovery in follow-up.

Clinically asymptomatic intracranial injury caused by transorbital penetration of a projectile foreign body

Clinically asymptomatic intracranial injury caused by transorbital penetration of a projectile foreign body

Case Report: Transorbital approach for the management of an orbito-temporal penetrating brain injury (skull base region) secondary to wooden spikes

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.

Bamboo in the brain: Impalement injury over orbito-cranial region via superior orbital fissure

Intracranial wooden foreign bodies due to transorbital penetrating injury sparing orbital globe are relatively rare with no reported cases till date. A multidisciplinary approach with multiple imaging modalities is needed for preoperative surgical planning.
 In this case report, we report a case of 3-year-old male who presented to our emergency department with history of fall from 5 feet with no vision over right eye. ~2cm cut injury with sutures in situ was present over nasal ridge with pus discharge. CT scan head showed foreign body over temporal region. Right fronto-temporo-orbito-zygomatic craniotomy with removal of foreign body was done. Deep seated abscess seen over temporal fossa was evacuated and post-operatively intravenous antibiotics was continued. Contrast enhanced CT repeated on 15th post-operative day showed no remaining abscess or foreign body. The patient was discharged on oral antibiotics. The wound healed completely with no improvement of vision in 1-week follow-up.
 Keywords: brain abscess, orbito-cranial penetrating injury, wooden foreign body

A case report on the unusual facial injuries: Impalement injuries

Introduction: Impalement injuries are comparatively rarer in nature than other types of injuries. They mostly affect the extremities, whereas the face is rarely involved. They are defined as penetrating injuries, wherein a traumatic object gets impaled in the human body. Impalement injuries of the face present to the emergency. The approach and management of such injuries remain controversial and requires a multi-team approach. We report a case of an impalement injury of the face along with its successful management. Case Report: An interesting case of transorbital penetrating injury is presented. An 8-year-old male child presented in the emergency trauma centre with an alleged history of fall from the first floor of his house resulting in a penetrating injury by a roof tile 'Khaprail' to his face and skull. Conclusions: Impalement injuries to the face and skull require a prompt action, multi-team approach and urgent surgical intervention to prevent damage to salvageable vital tissues. A thorough knowledge of relevant surgical anatomy and a disciplined surgical hand is imperative for optimal results.

Orbital Apex Syndrome and Carotid Artery Injury Associated with Transorbital Stab Injury

Transorbital penetrating injuries are particularly rare in the adult population. We present a case of TOPI sustained in an assault using a ballpoint pen-with concomitant transmaxillary injury due to a pencil stab wound-and a review of the literature.

Minimally invasive treatment of transorbital penetrating injury of skull base and cavernous sinus: A case report

Introduction. A transorbital intracranial injury with a foreign body can be a very complex and controversial therapeutic problem. The orbit's content is susceptible to penetrating trauma, and neurovascular skull base structures are at high risk from injury. There are some traditional cranial surgical approaches and more recently reported different endoscopic approaches for treating this kind of injury. Case report. We presented a case of a 30-year-old male who had an accident at work when a piece of wood hit him in his head and entered through the medial aspect of his left orbit with skull base and cavernous sinus injury. Rapid and complete radiological and clinical assessments were performed, and the patient was treated in a minimally invasive manner. The foreign body was manually extracted with an endoscopic and endovascular team ready to treat adverse events. No postoperative complications were reported, and visual acuity increased at the one-month follow-up. Conclusion. Penetrating wounds of the orbit represent a challenge that re-quires a multidisciplinary assessment and well-organized management. Combined endoscopic minimally invasive approaches should be considered during the treatment of this kind of injury.

A Case of Transorbital Penetrating Cavernous Sinus Injury by a Bamboo Stick Treated by Craniotomy in the Hybrid Operating Room

Herein, we report a rare case of penetrating transorbital cavernous sinus injury caused by a bamboo stick, treated by craniotomy in a hybrid operating room. A 63-year-old gardener presented at our hospital with right upper orbital injury after falling on a bamboo basket. Neurological examination revealed right II, III, IV, and VI cranial nerve palsies. CT and MRI revealed a right transorbital penetrating injury by a small sharp wooden foreign body, extending from the orbit to the cavernous sinus via the superior orbital fissure. Preoperative digital subtraction angiography revealed partial occlusion of the right cavernous sinus by the foreign body and no internal carotid artery(ICA)injury. There was a nine-day waiting period after the injury because the patient was on dual antiplatelet therapy for ischemic heart disease. Subsequently, the bamboo stick was completely removed through the right fronto-temporo-orbito-zygomatic approach in a hybrid operating room. To treat the potential massive hemorrhage, a five-French balloon catheter was inserted in the right ICA at its origin via the right transfemoral approach before the craniotomy. The bamboo stick was completely removed with minor hemorrhage in the cavernous sinus; this was controlled using hemostatic materials. The postoperative course was uneventful. The patient was discharged with blindness and total ophthalmoplegia in the right eye but he was able to return to his prior job. This is the first report of such a treatment of a transorbital penetrating injury in a hybrid operating room.

Management of Transorbital Penetrating Intracranial Injury by a Homemade Metal Arrow: Serials Case Report

BACKGROUND: Transorbital penetrating intracranial injury (TOPI) is rare lesions, representing about 0.4% of traumatic brain injury. This uncommon injury has potentially severe and fatalities brain damage with high mortality rate if not promptly treated.
 CASE REPORT: We presented three patients with TOPI following penetration by a homemade metal arrow; unfortunately, two patients (cases 1 and 2) death on arrival at our hospital. As a survival patient (case 3), a 15-year-old boy presented with a homemade metal arrow entered through a right superior orbital fissure into the right cerebral hemisphere. Plain skull radiograph showed that the tip of the shaft was located in the right of the posterior cerebral hemisphere and confirmed by computerized tomography (CT) and three-dimensional CT of his brain. Injury to the right middle cerebral arteries was apparent on non-contrast CT angiography. Using a right occipital craniotomy approach with C-arm radiography fluoroscopy guidance, we successfully removed the arrow. Follow-up studies confirmed an excellent outcome.
 CONCLUSIONS: Pre-operative imaging is mandatory to evaluate the trajectory, brain, and vascular injury for appropriate surgical planning and post-operative care of patients with TOPI.

A case of transorbital penetrating head injury by the broken blade of a powered lawn trimmer

A case of transorbital penetrating head injury by the broken blade of a powered lawn trimmer

Transorbital penetrating trauma caused by a fall on the antenna of a radio receiver: Case report and review

Summary We report the case of a patient who died after falling on the antenna of a radio receiver that was stood on the floor. External examination showed an orificial contuse wound, less than a centimetre in diameter, on the right upper eyelid. There was no ocular lesion. Full-body CT (computed tomography) scan imagery revealed a fracture of the roof of the right orbit and diffuse intra and pericerebral haemorrhages. Those haemorrhages had caused the death of the patient. Penetrating transorbital traumas represent a very small part of cranial traumas and orbital pathologies. They are usually linked to the high-velocity traumas associated with traffic accidents or penetration by firearm projectiles. Low-energy penetrating transorbital traumas are even less frequent; associated prognoses are rarely lethal and generally functional. These traumas cause minimal palpebral or periocular wounds that can seem insignificant upon external forensic examination, especially when the foreign body involved is fully intracranial or absent. Performing a cerebral scan, or even post-mortem angiography, thus appears to be a key-procedure, very useful to the medical examiner.

David Prudhomme en immersion profonde

A foreign object penetrating the brain via orbit is a rare occurrence. Accurate diagnosis and immediate intervention is essential to prevent ophthalmic or neurological deficits and to reduce chances of infection or hemorrhage.We report 2 cases of transorbital orbitocranial penetrating injury of metal objects in children. Computed tomography scan was obtained to assess the extent of the injury and to locate the objects. According to the trajectory, the best craniotomy approach was performed, and the objects were safely removed without any complication. Our cases are unique because of the absence of any neurological deficit on admission, before and after the removal.The importance of transorbital orbitocranial penetrating injury cannot be neglected because of possible orbital and intracranial damage. Therefore, in this report we aim to heighten awareness of the complexity and severity of transorbital penetrating brain injury.

Percutaneous endoscopic removal of a residual foreign body at the orbital-cranial region after transorbital penetrating injury: a novel minimally invasive technique

BackgroundThe orbit is susceptible to traumatic injuries, and surgical management of transorbital penetrating injury with foreign body retention is challenging due to the associated risks of nervous and vascular injury. Application of multiple imaging modalities is helpful for the preoperative surgical planning, and technical advances in percutaneous endoscopy would render the surgical approach even less invasive.Case presentationWe present a 60-year-old female patient with a transorbital penetrating injury (TPI) caused by a bamboo stick in her right eye. The bamboo stick was initially pulled out at the emergency room but, 1 month later, massive bleeding from her nose and mouth occurred. CT and CTA revealed a foreign body in the right orbito-cranial region and a traumatic aneurysm at the right internal carotid artery. Endovascular embolization was first delivered to treat the aneurysm, and the remains of the bamboo stick were completely removed with a percutaneous endoscope. The patient was discharged 1 week later.ConclusionsA careful preoperative examination by multiple imaging modalities, e.g., CT, MRI, and DSA are essential for the correct diagnosis and surgical planning for the patient with a TPI. We minimised the associated risks of vascular and nervous injuries during foreign body removal by sequential application of the endovascular intervention and percutaneous endoscopic technique.

Neurosurgical management uncommon transorbital penetrating brain injury in children

O bjective − To evaluate the optimal neurosurgical treatment of rare paediatric transorbital penetrating brain injuries. C ase report − A 6 year-old male patient was admitted to the Department of Emergency Medicine of Zenica Cantonal Hospital, Bosnia and Herzegovina, be- cause of an injury to the right eye caused by a knife. The patient was fully conscious, oriented, hemodynamically stable and without any neurological deficit and with a Glasgow Coma Scale score of 15. Computed Tomography showed a knife blade entering the right orbital roof and the medial part of the right frontal lobe, with an underlying tract hematoma. The patient underwent bifrontal craniotomy. The knife was removed carefully. There were no signs of vascular or related injuries on the trajectory. After surgery, the eye was examined by an ophthalmologist. The patient recovered fully and was discharged about ten days after surgery. Conclusion − Early surgery with a multidisciplinary approach is indicated in patients with transorbital penetrating brain injury to prevent serious complications. The outcome depends on the type of object, the point of entry, the trajectory, the extent of parenchymal injury, the presence of vascular injury, adequate dural closure and septic complications. .

Clinical Curiosity: Transnasal Head Trauma Caused by a Toilet Paper Holder

The risk of severe head injury during a seizure is usually small. Penetrating bony injuries to the skull caused by a fall on a sharp object during a seizure account for less than 3% of all ictal head injuries. Only few reports have been published on transoral, transnasal, and transorbital penetrating injuries suffered by patients who fell during a seizure. We report on a case of transnasal penetrating injury extending to the skull base and its treatment in a patient who fell on a toilet paper holder.

Patient Survival after a Very Deep Penetrating Orbitocranial Injury.

Patient Survival after a Very Deep Penetrating Orbitocranial Injury.

Transorbital Penetrating Head Injury (TOPHI): Short Series of Two Cases with Review of Literature

Transorbital Penetrating Head Injury (TOPHI): Short Series of Two Cases with Review of Literature

WITHDRAWN: Trans-orbital penetrating head injury (TOPHI): Short series of two cases with review of literature

WITHDRAWN: Trans-orbital penetrating head injury (TOPHI): Short series of two cases with review of literature