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Avraham E, Smolikov A, Smolyakov R, Azriel A, Sufaro Y, Kaisman-Elbaz T, Zlatin G, Melamed I. Minimally Invasive Subtemporal Intradural Approach for Penetrating Orbitocranial Injury by Wooden Foreign Body Into the Lateral Wall of the Cavernous Sinus. Front Surg 2020; 7:533567. [PMID: 33195384 PMCID: PMC7536401 DOI: 10.3389/fsurg.2020.533567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
Non-missile transorbital penetrating head injuries are relatively rare, though potentially fatal injuries. Trajectory for intracranial entrance is typically via the orbital roof, the superior orbital fissure (SOF), or the optic canal. Non-metallic intracranial penetrating injuries are even scarcer and may pose unusual diagnostic and surgical challenges. Here we present and discuss a unique case of a penetrating injury by a wooden foreign body (FB) which entered and expanded the inter-dural space of the lateral cavernous sinus (CS) sinus wall without intracavernous or intradural involvement. The patient was a 71 year-old male who fell face-down and sustained a penetrating transorbital injury by a dry twig fragment, which passed through the SOF and into the interdural space of lateral wall of the ipsilateral CS. The patient was fully conscious (GCS15) at presentation but had severe ocular injury (complete ophthalmoplegia and blindness of the injured eye). The wooden FB was successfully removed via a minimally invasive subtemporal intradural approach with no apparent immediate or long-term complications. We emphasize the unusual diagnostic and surgical challenges related to this kind of rare injuries as reflected by the decision-making considerations taken in the presented case.
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Affiliation(s)
- Elad Avraham
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
| | - Alexander Smolikov
- Department of Radiology, Soroka University Medical Center, Beersheba, Israel
| | - Rozalia Smolyakov
- Infectious Diseases Unit, Soroka University Medical Center, Beersheba, Israel
| | - Amit Azriel
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
| | - Yuval Sufaro
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
| | | | - Gregory Zlatin
- Department of Otorhinolaryngology (ENT), Soroka University Medical Center, Beersheba, Israel
| | - Israel Melamed
- Department of Neurosurgery, Soroka University Medical Center, Beersheba, Israel
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Wu Y, Chen T, Yuan M, Mzimbiri JM, Liu Z, Chen Y, Luo X, Chen F, Liu J. Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review. Front Neurol 2020; 11:591431. [PMID: 33281731 PMCID: PMC7689382 DOI: 10.3389/fneur.2020.591431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023] Open
Abstract
Orbitocranial penetrating injury (OPI) with multiple vascular invasions is a rare occurrence. To our knowledge, experience with its clinical treatment is rather limited, especially for infants. This case report describes an infant who fell from a 0.5 m high bed and landed on a toy with a keen-edged plastic rod. The fractured end of the rod was noted at the medial aspect of the left eyelid, and she was experiencing impaired consciousness. Computed tomography showed that the foreign body penetrated the cavernous sinus with internal carotid artery involvement, and compressed the transverse sinus through the cerebellum. Emergency surgery was performed with temporal occlusion of the left common carotid artery. The rod was removed from the orbital side, and bleeding from cavernous sinus region was effectively controlled under direct inspection via a sub-temporal approach. The patient was successfully treated and recovered consciousness after 17 days. This is the first report of successful management of OPI combined with multiple vascular injury in an infant. Herein, we highlight the anatomical imaging features of the injuries and also the individualized strategy concerning vascular invasion.
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Affiliation(s)
- Yun Wu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Tiange Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Meng Yuan
- Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Ziyuan Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Yilei Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Xiangying Luo
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jinfang Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
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Huang T, Ling J, Liu M, Qiu C, Ding G, Huang J, Krischek B, Yang S, Zheng F. Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report. J Int Med Res 2019; 48:300060519886210. [PMID: 31840553 PMCID: PMC7607224 DOI: 10.1177/0300060519886210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A transorbital penetrating injury by a foreign body is an extremely rare type of injury,
and its severity is often difficult to estimate by examination of the superficial wound
alone. Thus, such injuries are challenging for neurosurgeons to investigate and manage. We
herein present a peculiar case involving a 3-year-old girl with a penetrating transorbital
skull-base injury caused by a coloring pencil and discuss the anatomical location of the
foreign body, radiological examination findings, diagnosis, and treatment strategy. The
pencil was completely removed by manual extraction. Follow-up investigations confirmed a
good outcome. Multidisciplinary cooperation, radiological examination, correct diagnosis,
timely treatment, and detailed follow-up studies are necessary to manage penetrating
transorbital skull-base injuries caused by foreign bodies. The orbital walls are very thin
in children, and the orbital roof and superior orbital fissure are often penetrated by
foreign bodies in cases such as that described herein. The anatomical location of the
foreign body influences the clinical management strategy.
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Affiliation(s)
| | - Jun Ling
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Ming Liu
- Gannan Medical University, Jiangxi, China
| | - Chuanzhen Qiu
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Guanfu Ding
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Jun Huang
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Boris Krischek
- Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Shaochun Yang
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Feng Zheng
- Department of Neurosurgery, First Affiliated Hospital of Gannan Medical University, Jiangxi, China.,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases of Ministry of Education, Gannan Medical University, Ganzhou, China
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El-Anwar MW. A Rare Penetrating Trauma of Both Orbit and Nasal Cavity. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2018; 30:365-367. [PMID: 30560104 PMCID: PMC6291816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Diagnosis of orbital foreign body (FB) penetration is usually obvious when part of the FB is still attached at the entry wound (1). However, the depth and course of the FB in this case was not visible. CASE REPORT A 5-year old female presented with a pencil penetrating the left orbit. A computed tomography (CT) scan showed that the pencil penetrated the left orbit (extraseptal) through the lacrimal bone to the left nasal cavity, then perforated the nasal septum, crossing the right nasal cavity. Finally, the pencil penetrated the lamina paperatea to the right orbit and stopped near the right optic nerve. The pencil was gently removed under general anesthesia with close observation of the eyes. CONCLUSION A case of a pencil penetrating both orbits and nasal cavities was reported, and the pencil was safely removed. This draws attention to the possible penetration power of a pencil, with the possibility of injury to the orbit and optic nerve on the opposite side of the penetration. It also demonstrates the feasibility of safe removal.
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Affiliation(s)
- Mohammad-Waheed El-Anwar
- Corresponding Author: Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt. Tel: 00201004695197, E-mail:
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Occult Orbital Injury with Dagger Fragment with Resulting Pneumocephalus. Case Rep Ophthalmol Med 2018; 2018:5093417. [PMID: 30319827 PMCID: PMC6167598 DOI: 10.1155/2018/5093417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/13/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Penetrating injuries of the cranium are relatively uncommon, only 0.4% of all head injuries. In patients with disturbed conscious level, an extensive examination should be performed in the emergency unit to rule out transorbital penetrating brain injury. A 25-year-old male was attacked with a dagger. He presented with ethylic intoxication and the physical examination demonstrated a small skin injury on the lateral canthus of the left eye with a large periocular hematoma which prevented eyelid opening. Cranial CT scan showed a metallic intraorbital foreign body consisting of a fragment of a dagger which perforated the eyeball, and penetrated through the superomedial wall of the orbit into the anterior cranial fossa. Reconstruction of the eyeball was performed and the fragment was removed. Orbital injuries with a knife in situ are very unusual. Early identification and removal of retained foreign bodies are essential.
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Rzaev DA, Danilin VE, Letyagin GV, Istomina TK, Chishchina NV. [Penetrating orbitocranial injury: a review of the literature and a case report of injury by a watercolor brush in a 3-year-old child]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:77-87. [PMID: 28524129 DOI: 10.17116/neiro201781277-87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a rare case of orbitocranial penetrating injury by a watercolor brush in a 3-year-old child. Injuries of this localization can affect important orbital structures (eyeball, blood vessels, nerves, muscles) and cause severe intracranial damages. In some cases, diagnosis of these injuries in children may be difficult due to the lack of marked clinical manifestations. The presented clinical case illustrates the approaches for choosing methods for diagnosis of injury in childhood and subsequent treatment options.
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Affiliation(s)
- D A Rzaev
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | - V E Danilin
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | - G V Letyagin
- Federal Center of Neurosurgery, Novosibirsk, Russia
| | - T K Istomina
- Federal Center of Neurosurgery, Novosibirsk, Russia
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Rezaei H, Alenabi A, Dahmardeh M, Nasri-Nasrabadi Z, Marashi SM. Patient Survival after a Very Deep Penetrating Orbitocranial Injury. Sultan Qaboos Univ Med J 2016; 16:e121-2. [PMID: 26909205 DOI: 10.18295/squmj.2016.16.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/02/2015] [Accepted: 08/23/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hamid Rezaei
- Department of Neurosurgery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Anita Alenabi
- Department of Pathology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mostafa Dahmardeh
- Department of Plastic Surgery, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Sayed Mahdi Marashi
- Emergency Room & Division of Medical Toxicology, Hazrat-e Ali Asghar Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Transorbital stab injury with retained knife: a narrow escape. Case Rep Crit Care 2014; 2014:754053. [PMID: 25328717 PMCID: PMC4189941 DOI: 10.1155/2014/754053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022] Open
Abstract
Transorbital penetrating injuries are unusual but may cause severe brain damage if cranium is entered. These kinds of injuries are dangerous as the walls of orbit are very thin, hence easily broken by the otherwise innocent objects. Because of the very critical anatomical area involved, these injuries pose a serious challenge to the physicians who first receive them as well as the treating team. These may present as trivial trauma or may be occult and are often associated with serious complications and delayed sequel. Prompt evaluation by utilizing best diagnostic modality available and timely interference to remove them are the key aspects to avoid damage to vital organs surrounding the injury and to minimize the late complications. We report a case of transorbital assault with a 13 centimeter long knife which got broken from the handle and the blade was retained. The interesting aspect is that there was no neurological deficit on presentation or after removal.
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