Penetrating Head Injuries in Children:

Transorbital penetrating intracranial injury, with cavernous sinus involvement

Transorbitary intracranial penetrating traumatic injuries are uncommon in the paediatric population, and may occur in the context of domestic, sporting or school accidents. They can extend to skull base and compromise vascular structures such as cavernous sinus and internal carotid. We present a case of 6 years-old girl that suffered an intracranial transorbital penetrating injury with a wooden pencil that crossed from the medial edge of left orbit, transetmoidal and trans-sphenoidal, entering the right sellar region and leaving its end in contact with carotid artery (cavernous segment). After pre-surgical studies, foreign body removal was performed with endoscopic surgery + endovascular control in case of carotid injury. After removing the foreign body, a CSF fistula occurred and was repaired. Patient recovered adequately, without neurological deficit, without postoperative CSF fistula, without CNS infection or oculomotor alteration.

Fatal penetrating orbitocerebral injury by bicycle brake handle

Accidental penetrating head injuries are rare but significant cause of morbidity in children. We report a case of a nine-year-old who sustained a fatal trans-orbital penetrating injury following a fall from bicycle. The plastic sheath of the metal brake handle was lodged intracranially, injuring the brainstem. The CT scan features and autopsy findings are described.

Transorbital penetrating cerebral injury caused by a wooden stick: surgical nuances for removal of a foreign body lodged in cavernous sinus

PURPOSE

Penetrating head injury (PHI) is rare in civilian population and is mostly caused by low-velocity modes. A transorbital penetrating intracranial injury is very rare and more severe than traumatic brain injury.

METHODS

We report a rare case of transorbital penetrating cranial injury caused by a wooden stick. The surgical strategy was planned as the wooden stick was lodged in the right cavernous sinus.

RESULTS

The wooden stick was successfully removed. Patient made an uneventful recovery.

CONCLUSIONS

Transorbital penetrating injuries are uncommon form of injury and require a multidisciplinary approach. No attempt should be made to remove the foreign body without the backup of an operating room because of the possibility that the object may be tamponading an injured vessel. A careful planning and a strict adherence to basic perioperative principles can lead to a satisfactory outcome.

Fatal penetrating head injury by bamboo fragments

Penetrating head injury by foreign body is relatively uncommon and has been scattered reported in the literature. In this case, a transorbital impalement wound inflicted by bamboo objects was discussed. A 61-year-old alcoholized man died from a transorbital intracranial wound due to penetration of the left orbit after falling from a slope beside the road. Although the facial impalement injury was small and unobtrusive, the penetrating trauma itself could induce lethal consequences, special attention should be paid to such kind of cases. The autopsy and pathological examination revealed subarachnoid hemorrhage, brain contusion and intraparenchymal hematoma. Some pieces of bamboo were also detected in the left anterior cranial fossa. Based on all of the evidence and information, we can draw a conclusion that the bamboo was the instrument causing the injuries and the case was considered as accident.

The anatomy of the callosomarginal artery: applications to microsurgery and endovascular surgery

BACKGROUND

The callosomarginal artery (CMA), the main branch of the pericallosal artery, courses in or near the cingulate sulcus and gives rises to 2 or more major cortical branches. There is confusion about the artery best fitting the definition of "callosomarginal artery." Distal anterior cerebral artery aneurysms represent 1.5% to 9% of intracranial aneurysms, and most often occur at the origin of the CMA. The microsurgical anatomic features of the CMA, its relationship with the pericallosal artery, and clinical implications are presented.

METHODS

The origin, course, branching pattern, and diameter of the CMA and its branches and its relationship with the pericallosal artery were studied in 60 cerebral hemispheres, including cadaveric dissections and angiographic images.

RESULTS

The CMA was present in 93.3% of hemispheres studied and arose mainly from A3 (55.2%), a mean of 3.11 +/- 1.90 cm from the anterior communicating artery. The mean diameter of the CMA at its origin was 1.53 +/- 0.36 mm. The CMA ran 1.28 +/- 0.89 cm until its first branch, describing an anterior convex curve backward and upward (60.7%). An average of 3 lesser branches originated from the CMA. The most consistent branch was the posterior internal frontal artery (67.9%). The mean diameter of the CMA branches was 0.93 +/- 0.33 mm.

CONCLUSION

These morphometric measurements can help neurosurgeons access lesions located in distal intracranial vessels. The vessel coursing the longest pathway in or near the cingulate sulcus and otherwise following Moscow's classic definition should be considered the CMA.

Fatal transorbital head injury by bicycle brake handle

Accidental transorbital head injuries are quite rare. Penetrating head injuries by blunt objects are possible when the site of penetration is through the orbit or the thin temporal bone. The present case is a rare case of transorbital penetrating head injury by a blunt object - bicycle brake handle. Minor external wounds may be misleading and fatal consequences may ensue if cerebral damage is missed on diagnosis. Proper antibiotic coverage to prevent meningitis and neurosurgical intervention can reduce mortality in such cases.