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

Abstract

Background: Nonmissile anterior skull-base penetrating brain injuries (NASBPBIs) have specific characteristic features that are different from missile injuries. Our study presents our experiences on the characteristic features as well as management of NASBPBI. Materials and Methods: We retrospectively reviewed 22 consecutive patients with NASBPBI managed at our institute during a 13-year period. The mechanism of injury, clinical investigations, and complications were analyzed, with more emphasis on diagnostic and treatment regimen. Results: The 22 cases included in our study comprise of 20 males and 2 females. Majority (72.7%) of the patients were adults with a mean age of 27.5 years. The mechanisms of injury often include accidental fall, either onto a small-diameter sharp object (10 cases) or while carrying such an object in the hand (4 cases). The other common mechanisms were stabbing, accident, or during an altercation (8 cases). Clinical manifestations included periorbital hematoma (10 cases, 45.5%) and cerebrospinal fluid rhinorrhea or orbitorrhea (4 cases, 18.2%) as well as signs of embedded foreign object (8 cases, 36.4%). We performed emergency craniotomy in 21 cases and skin debridement in one case. Postoperative complications were abscess (1 case), epilepsy (1 case), and traumatic carotid-cavernous fistula (1 case). Conclusion: Nonmissile injuries are generally on the rise and therefore deserve more attention. We observed that clinical outcomes were excellent in 14 (Glasgow Outcome Scale [GOS] score of 5) and good in the remaining 8 patients (GOS of 4) during 6-month–10-year (mean 4.6 years) follow-ups.

Reversible cerebral vasospasm and cerebral infarction secondary to meningitis following penetrating head trauma with bamboo

“…Clinical manifestations included periorbital haematoma (10 cases, 45.5%), spinal fluid rhinorrhoea/orbital haemorrhage (4 cases, 18.2%) and signs of foreign body contamination (8 cases, 36.4%). Emergency craniotomy was performed in 21 cases and dermabrasion in 1 case, and all patients underwent surgery 8…”

Surgical Management of a Penetrating Brain Wound and Associated Perforating Ocular Injury Caused by a Low-Velocity Sharp Metallic Object: A Case Report and Literature Review

“…Although relatively rare and less destructive than missile injuries, non-missile PTBIs are dangerous and potentially lethal when vital neural and vascular endocranial structures are involved ( 1 ). Nonetheless, such injuries are generally on the rise and therefore deserve more attention ( 18 ). There are injuries of the low-velocity type, having a defined impact velocity of less than 100 meters per second ( 4 ).…”

Introductory Chapter: Penetrating Skull Base Injuries

“…In addition to careful and systematic clinical examination, radiological imaging has improved our approach to detect PSBIs as it will show the presence and route of foreign bodies and, extent of injury to bones and brain parenchyma [21]. The modalities of imaging include CT scan (including 3-D reconstruction) with bone window, MRI, X-ray skull, and in ocular route of entry, the ultrasound imaging of the orbit and its contents [1,37]. The presence of radiopaque foreign bodies including metallic foreign bodies can be well visualized on CT scan and radiographs, however, organic foreign bodies including peanut, wood, or bamboo pieces may be missed [4][5][6][38][39][40].…”

“…Penetrating skull base injuries (PSBI) can be caused by a range of mechanisms, and present a diagnostic and management challenge [1][2][3][4][5]. Usually, these injuries are caused by sharp objects, and these objects get entry into the skull via oro-cranial, transorbital intracranial, or transnasal routes [6][7][8].…”

“…A range of objects have been reported to cause PSBI raging from toilet brush handle, arrows, chopsticks, flatware, screwdrivers, keys, car antenna aerials, scissors, knives, pitchforks, crochet hooks, knitting needles, breech pins, umbrella bibs, crowbars, and iron rods [4][5][6][7][10][11][12][13][14][15][16][17][18]. There is an ongoing need to better understand PSBIs including associated complications, and to develop effective management protocols for these sub-groups of traumatic brain injuries [1,[19][20][21][22][23][24].…”