Transorbital penetrating brain injury by a wooden stick: A neuro-ophthalmologic emergency

Behera, Sasmita; Panigrahi, Souvagya; Mishra, Sudhansu Sekhar; Senapati, Satya Bhusan

doi:10.4103/1793-5482.145092

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…TOPBI secondary to nonprojectile is a rare incident. 5,6 The orbit is a horizontal pyramid-shaped structure with thin bony walls vulnerable to breach. The frequent path of penetration is via the roof due to the fragility of the superior orbital plate, often resulting in frontal lobe damage, as in our case.…”

Section: Discussionmentioning

confidence: 99%

When a Transorbital Penetrating Brain Injury Reveals the Infratentorial Tumor: A Case Report and Technical Note

Champeaux-Depond

Passeri²

2023

Indian Journal of Neurotrauma

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A 62-year-old man was referred for a transorbital injury. A preoperative computed tomography scanner confirmed an 8 cm long × 14 mm wooden piece penetrating the right orbit and perforating the anterior cranial base until the frontal lobe with no apparent prominent vascular injury. However, an unexpected posterior fossa tumor causing blocked hydrocephalus was unveiled. Extraction of the wooden stick was safely achieved after intracranial exploration followed by meticulous cleaning and careful watertight closure to prevent cerebrospinal fluid (CSF) leakage. Except the right eyesight loss, he initially recovered well, were it not for his hard-to-treat hydrocephalus. What at the time of its discovery seemed to be a less important but very likely the indirect cause of its injury, became unexpectedly problematic. Despite all CSF diversion procedures, the patient worsened gradually. Neither a failed attempt to remove the tumor due to the fourth ventricle floor broad infiltration nor the posterior fossa decompressive craniectomy succeeded in improving his neurological status. Despite the diagnosis of a grade II ependymoma, the tumor demonstrated an aggressive radiological behavior with an intense edema of the brainstem, possibly the cause of his drowsiness. Unfortunately, he died of tumor progression solely 52 days after his transorbital injury.

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Section: Discussionmentioning

confidence: 99%

When a Transorbital Penetrating Brain Injury Reveals the Infratentorial Tumor: A Case Report and Technical Note

Champeaux-Depond

Passeri²

2023

Indian Journal of Neurotrauma

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“…OPI are highly morbid injuries with associated acute, subacute, and long-term complications, which require management by ophthalmology, neurosurgery, and infectious diseases. 2,3,7,12 When feasible, debridement of the foreign body is advisable. Furthermore, given the risk of abscess formation, postoperative antimicrobial management is important and targeted antibiotics should be administered as microscopic splinters are unlikely to be removed in entirety.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6] Orbitocranial penetrating injuries (OPIs) frequently penetrate through the thin bones of the orbital roof, often directed towards ABBREVIATIONS: OPI, orbitocranial penetrating injury; PBI, penetrating brain injury these sites due to the conical shape of the orbit. 5,7 This report summarizes use of an orbitofrontal craniotomy through a supraciliary brow approach to successfully manage an OPI from a tree branch with excellent recovery and was submitted with Institutional Review Board approval with formal written patient consent. The patient consented to publication of their photo.…”

Section: Abstract: Orbital Penetrating Injury Minimally Invasive Cran...mentioning

confidence: 99%

Removal of a Penetrating Tree Branch in the Orbitofrontal Region—A Unique Application of an Orbitofrontal Craniotomy Through a Supraciliary Brow Approach

et al. 2021

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BACKGROUND AND IMPORTANCE Orbitocranial penetrating injury (OPI) is associated with neurological, infectious, and vascular sequalae. This report describes unique application of an orbitofrontal craniotomy through a supraciliary approach to remove a wooden stick penetrating through the orbit and frontal lobe, postoperative management, and antimicrobial therapy. CLINICAL PRESENTATION A 51-yr-old male presented after a tree branch penetrated beneath his eye. He had no loss of consciousness and was neurologically intact with preserved vision and ocular motility. Computed tomography (CT) and CT angiogram revealed an isodense hollow cylindrical object penetrating though the left orbit and left frontal lobe. The object extended into the right lateral ventricle, abutting the left anterior cerebral artery. There was minimal intraventricular hemorrhage without arterial injury. The patient was treated with broad-spectrum antimicrobial coverage. The foreign body was removed and the dural defect repaired via an orbitofrontal craniotomy through a supraciliary eyebrow incision. He was treated with an extended course of antimicrobial therapy, and after 18 mo remained neurologically intact. CONCLUSION OPI are a subset of penetrating brain injuries with potential for immediate injury to neurovascular structures and delayed complications including cerebrospinal fluid leak and infection. Treatment includes attempted complete removal of the foreign body and antimicrobial therapy. An orbitofrontal craniotomy through a supraciliary eyebrow incision may be effective in selected patients.

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“…Whereas many such traumas result in a fatality, there are reports of patients with a good outcome. [1][2][3][4][5][6][7][8][9] In most of these cases, this is due to the velocity of the impact, with low-velocity impacts tending to result in a better outcome. 7 Due to the bony structure of the orbita, objects are funneled toward the optic canal where they can easily penetrate the thin walls.…”

Section: Discussionmentioning

confidence: 99%

Surviving a Self-inflicted Transorbital Pen Intrusion to the Cerebellum: Case Report

Breuskin

Ketter

Oertel

2021

J Neurol Surg A Cent Eur Neurosurg

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Background Although intracranial traumas by penetrating foreign objects are not absolute rarities, the nature of trauma, the kind of object, and its trajectory make them a one of a kind case every time they occur. Whereas high-velocity traumas mostly result in fatalities, it is the low-velocity traumas that demand an individualized surgical strategy. Methods We present a case report of a 33-year-old patient who was admitted to our department with a self-inflicted transorbital pen injury to the brain. The authors recall the incident and the technique of the pen removal. Results Large surgical exposure of the pen trajectory was considered too traumatic. Therefore, we opted to remove the pen and have an immediate postoperative computed tomography (CT) scan. Due to its fragility, the pen case could only be removed with a screwdriver, inserted into the case. Post-op CT scan showed a small bleeding in the right peduncular region, which was treated conservatively. The patient was transferred back to intensive care unit and woken up the next day. She lost visual function on her right eye, but suffered from no further neurologic deficit. Conclusion Surgical management of removal of intracranial foreign bodies is no routine procedure. Although some would favor a large surgical exposure, we could not think of an approach to do so without maximum surgical efforts. We opted for a minimal surgical procedure with immediate CT scan and achieved an optimal result. We find this case to be worth considering when deciding on a strategy in the future.

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Transorbital penetrating brain injury by a wooden stick: A neuro-ophthalmologic emergency

Cited by 10 publications

References 5 publications

When a Transorbital Penetrating Brain Injury Reveals the Infratentorial Tumor: A Case Report and Technical Note

When a Transorbital Penetrating Brain Injury Reveals the Infratentorial Tumor: A Case Report and Technical Note

Removal of a Penetrating Tree Branch in the Orbitofrontal Region—A Unique Application of an Orbitofrontal Craniotomy Through a Supraciliary Brow Approach

Surviving a Self-inflicted Transorbital Pen Intrusion to the Cerebellum: Case Report

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