Penetrating orbital trauma leading to trans-orbital brain herniation

Abstract

The child improved gradually, and at 6 months follow-up, he had good cosmetic outcome with improvement of vision.

Reconstruction of a Combined Frontal Bone and Orbital Roof Defect With Associated Meningoencephalocele Using 3D Modeling and 3D Navigation

“…4 This may not be necessary in all patients but in cases where the dura has been breached a watertight seal is mandatory. 6,7,10,13 Even though there was no dural tear in our patient, the dura was opened to remove the frontal lesion, and was sealed using a vascularized pericranium flap, gelatin sponge, Tacho-Seal® and fibrin glue, which in our experience seems to be sufficient. 31…”

“…4 This may not be necessary in all patients but in cases where the dura has been breached a watertight seal is mandatory. 6,7,10,13 Even though there was no dural tear in our patient, the dura was opened to remove the frontal lesion, and was sealed using a vascularized pericranium flap, gelatin sponge, Tacho-Seal ® and fibrin glue, which in our experience seems to be sufficient. 31 In an effort to standardize treatment Connon et al proposed a classification system of orbital roof fractures based on their clinical appearance 27 : This was further subclassified to include associated facial fractures, neurological injuries, orbital injuries and frontal sinus injuries.…”

“…5 The presence of a progressive encephalocele causing pulsatile exophthalmos in an orbital roof injury would fall into the category of potential visual impairment, and so in this particular situation surgical repair is advocated. 4,5,10,18 Although treatment of traumatic orbital roof meningoencephaloceles varies from 1 individual to another, there are common themes to the surgical approach employed that are summarized in Table 1, [4][5][6][7][8][9][10][12][13][14]17,18 and from which a treatment algorithm modified from those previously reported has been produced (Figure 5). 5,27…”

“…1,2 A traumatic encephalocele that complicates the fracture site, which was first described in 1949, 3 is even rarer with only 24 case reports published in the English-speaking literature to date. 3 –26 The majority of these were in the pediatric population as the added protective layer of a pneumatized frontal sinus is not yet developed.…”

Orbital Penetrating Injuries: A Review on Evaluation and Management

“…77 One case report described delayed (3 days after injury) herniation of intracranial contents into the orbit in a child through an orbital roof fracture defect causing severe exophthalmos and vision loss. 58 Extra-orbital neurologic complications include but are not limited to gait ataxia, chronic central pain, hemiplegia, coma, and death. 11,78 One case report describes the development of an orbital inclusion cyst 3 years after penetrating orbital trauma.…”