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

Abstract

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.

Crayon in the Orbit and Sinuses in a Pediatric Patient

“…Perioperative antibiotics are needed as well due to the introduction of bacteria into the sinuses and intracranial cavity by the foreign body. 2,4 Penetrating orbital injuries have the potential to cause severe brain injury if the cranium is entered, typically via the orbital roof, superior orbital fissure, optic canal, or ethmoid roof similar to the case seen here. 6 Major neurological deficit in these cases may be delayed in presentation, and if a foreign body is retained in the orbit or cranium, severe infectious complications can be seen.…”

“…Perioperative antibiotics are needed as well due to the introduction of bacteria into the sinuses and intracranial cavity by the foreign body. 2,4…”

“…3 Overall, transorbital penetrating intracranial injuries make up about 0.4% of traumatic brain injuries and have the potential to be severe with a high mortality rate. 4 Case A 2-year-old male presented to the emergency department with a crayon embedded in his right eyelid inferior to the medial canthus after falling from his bed onto a green crayon that he was holding in his hand (Figure 1A). Computed tomography (CT) scan revealed penetrating injury in the right inferomedial orbital rim that extended through the lamina papyracea (Figure 1B) and then into the ethmoid sinus (Figure 1C), with the outside CT showing that the crayon had traversed the orbit with the tip extending to the sphenoid sinus (Figure 1D).…”

“…3 Overall, transorbital penetrating intracranial injuries make up about 0.4% of traumatic brain injuries and have the potential to be severe with a high mortality rate. 4…”

An extremely rare case: Transorbital penetrating intracranial injury by wooden foreign body. Case report

“…It is just found only 0,4% of all traumatic injuries with a major cause is the missile such bullet in the war trauma setting. Otherwise, nonmissile foreign bodies such as iron rods, wood, nail, and needle are even scarcer [ [1] , [2] ].…”