Management of Penetrating Skull Base Injury: A Single Institutional Experience and Review of the Literature

Abstract

Background Penetrating skull base injury (PSBI) is uncommon among head injuries, presenting unique diagnostic and therapeutic challenges. Although many cases of PSBIs have been reported, comprehensive understanding of its initial diagnosis, management, and outcome is still unavailable. Materials and Methods A retrospective review was performed for patients treated in neurosurgical department of Changzheng Hospital for PSBIs. Presurgical three-dimensional (3D) Slicer-assisted reconstructions were conducted for each patient. Then we reviewed previous literature about all the published cases of PSBIs worldwide and discussed their common features. Results A total of 5 patients suffering PSBIs were identified. Penetrating points as well as the surrounding neurovascular structures were clearly visualized, assisting in the presurgical planning of optimal surgical approach and avoiding unexpected vascular injury. Four patients underwent craniotomy with foreign bodies removed successfully and 1 patient received conservative treatment. All of them presented good outcomes after proper management. Conclusion Careful physical examination and radiological evaluation are essential before operation, and angiography is recommended for those with suspected vascular injuries. 3D modeling with 3D Slicer is practicable and reliable, facilitating the diagnosis and presurgical planning. Treatment decision should be made upon the comprehensive evaluation of patient's clinicoradiological features and characteristics of foreign bodies.

Transorbital-penetrating intracranial injury due to a homemade metal arrow: A case report

“…The complete structural anomaly encountered by the surgeon is not fully explained in planar reconstruction. The surgeon must have a three-dimensional image of the patient's skull abnormalities as a useful adjunct to surgical planning [ 15 , 19 ]. In this case, CT ( Fig.…”

“…Infection is the most-fatal complication of TOPIs, with reported overall rate of 64–70% and a mortality rate of 14–57% [ 19 ]. The incidence of traumatic brain abscesses in the civilian population ranges from 2.5% to 10.9% of total brain abscesses.…”

“…Regarding the selection of surgical timing, extremely early foreign-body removal may cause massive bleeding due to the change in the pressure gradient, while delayed surgery results in an increased risk of infection. The current recommendation is that surgery be performed within 12 hours [ 19 , 26 ].…”

Double Beveling on Imaging: A Characteristic Feature of Entry and Exit Penetrating Injury Wound

“…[5][6][7][8][9] A wide variety of mechanisms and objects can cause these penetrating craniofacial injuries. [10][11][12][13][14] Apart from the injuries to facial skeleton, penetrating craniofacial injuries can lead to damage to orbit and its contents, cerebrospinal fluid (CSF) leak and its sequel (risk of meningitis or abscess), intracranial hematomas, injury to neurovascular structures, and retained foreign bodies. 11,12,[15][16][17][18][19][20][21][22] Indian J Neurotrauma:2020;17:143-145…”

Nonmissile anterior skull-base penetrating brain injury: Experience with 22 patients

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