1
|
Paranathala MP, Crossman J, Jenkins A. Delayed presentation of bamboo foreign body in brainstem, with novel skull base foramen. Br J Neurosurg 2024; 38:992-994. [PMID: 34806507 DOI: 10.1080/02688697.2021.2005779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
We describe the extremely unusual case of a childhood injury to the skull base presenting after many years, as a foreign body with chronic granulomatous infection of the brainstem, mimicking neoplasm. TB had an inconsequential penetrating injury to the left cheek, from a bamboo spike aged 15. After 4 years, he developed worsening left sided weakness, imaging at this time was normal. After a car accident aged 40, the weakness worsened further and imaging demonstrated a foreign body entering the skull base. At its tip, it had caused a chronic granulomatous reaction within the brainstem. Surgical removal of this bamboo splinter was via an infratemporal, transzygomatic craniotomy and TB made a good recovery postoperatively. This unusual case demonstrates the important of close inspection of imaging, and thorough history taking. It also questions the chronology of the ossification of the skull base.
Collapse
Affiliation(s)
| | - John Crossman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| |
Collapse
|
2
|
A Rare Case of Orbitocranial Penetrating Injury with Intracranial Wooden Foreign Body Residue. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121832. [PMID: 36557035 PMCID: PMC9783578 DOI: 10.3390/medicina58121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
Orbitocranial penetrating injuries (OPIs) caused by wooden foreign bodies (WFBs) are very rare and life threatening. Their diagnosis and treatment could be challenging for an ophthalmologist, requiring us to remain alert for possible intracranial extension. We present a case of a 52-year-old man with a residual wooden foreign body in the left frontal lobe. He had a notable history of trauma from a fall on a tree stump and surgical removal of a wooden foreign body from his left orbit 6 years ago. He was referred to us due to recurrent discharge from the eyelid wound. Wooden foreign body residue was successfully removed with a carefully planned craniotomy without complications. This case describes the clinical manifestation, radiographic features, and treatment of this rare trauma, with an emphasis on imaging diagnosis and multi-disciplinary management.
Collapse
|
3
|
A case of death of purulent meningitis caused by transorbital intracranial penetrating injury due to long-term residual bamboo chopstick. Leg Med (Tokyo) 2022; 55:102012. [PMID: 34998200 DOI: 10.1016/j.legalmed.2021.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022]
Abstract
This article reports a case of death caused by purulent meningitis after a long-term transorbital intracranial penetrating injury induced by a bamboo chopstick. A 53-year-old man was pierced with a bamboo chopstick into the left orbit, and the bamboo chopstick broke off. The man remained conscious after the injury but developed paroxysmal headaches. Multiple computed tomography, computed tomography angiography, and rhinoscopy detections revealed that a puncture tract had formed from the left orbit to the right edge of the brainstem through the skull base. However, there was no apparent brain injury or cerebrovascular rupture, thus excluding the possibility of a retained intracranial foreign body by the neurosurgeon. Therefore, the man only received symptomatic and conservative treatments. Unfortunately, the man was found dead one morning, 13 months later. Autopsy and histopathological examinations revealed that he died of purulent meningitis caused by a long-term residual intracranial bamboo chopstick. A review of the relevant literature regarding the diagnosis, including diagnostic values and limitations of different imaging technologies, and treatment of residual intracranial foreign bodies, revealed that this was a case of misdiagnosis, leading to delayed treatment. This case had an indirect causal relationship between the victim's death and medical treatment. This article provides clinical strategies for diagnosing and treating such cases and a forensic perspective for identifying causes of deaths attributed to medical malpractices.
Collapse
|
4
|
Ren Y, You C. Management strategy of a transorbital penetrating injury by a wooden stick. Neurol India 2020; 68:509-511. [PMID: 32415036 DOI: 10.4103/0028-3886.284364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Yanming Ren
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Del Verme J, Giordan E, Marton E, Zanata R, Di Paola F, Canova G, Longatti P. Classification of orbitocranial wooden foreign body penetration injuries: what to do when they violate the intracranial space? A systematic review. J Neurosurg Sci 2019; 64:190-199. [PMID: 31738026 DOI: 10.23736/s0390-5616.19.04793-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Orbitocranial wooden foreign body (OWF) penetrations are rare but challenging occurrences that may violate the intracranial space resulting in brain damage and hemorrhagic, as well as infectious, complications. Moreover, there is a specific subset of cases of OWF penetrations that are particularly challenging to treat. Although there are well-defined management guidelines for pure intraorbital localization, there is not yet a defined treatment protocol for foreign bodies reaching the intracranial space. However, their removal performed either directly or through craniotomy, is often easily attainable given the condition that all necessary precautions are accounted for. EVIDENCE ACQUISITION After having treated a 48-year-old man with a transorbital OWF penetration injury at our neurosurgical department, we systematically reviewed the last 15 years of literature to define and summarize the best management strategy. Multiple databases were searched for case reports and case series involving patients with intraorbital and transorbital OWF penetration injuries. For each study, we extracted data on age, sex, imaging modality, type of wood (processed vs. unprocessed), location of periorbital and intracranial entry site, treatment type ("pull and see" or "open and see"), antibiotic therapy, and complications. EVIDENCE SYNTHESIS We classified transorbital OWFs into two categories: transorbital with only cavernous sinus involvement and transorbital with more extensive intracranial involvement. We described what we believed was the most appropriate management conduct in each case. CONCLUSIONS Grounded on our experience and on the review of the literature, we suggest, based on the anatomical localization of the OWF, a classification system for OWFs which is coupled with a tailored treatment strategy for each case. These suggestions are made to provide surgeons with direction on the correct management of such rare but challenging occurrences.
Collapse
Affiliation(s)
- Jacopo Del Verme
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy -
| | | | - Roberto Zanata
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | | | - Giuseppe Canova
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | | |
Collapse
|
6
|
MacLean MA, Mukhida K, Shankar JJS, Schmidt MH, Clarke DB. Complete recovery following transorbital penetrating head injury traversing the brainstem: case report. J Neurosurg Pediatr 2019; 24:697-701. [PMID: 31491753 DOI: 10.3171/2019.6.peds19106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
Transorbital penetration accounts for one-quarter of the penetrating head injuries (PHIs) in adults and half of those in children. Injuries that traverse (with complete penetration of) the brainstem are often fatal, with survivors rarely seen in clinical practice. Here, the authors describe the case of a 16-year-old male who suffered and recovered from an accidental transorbital PHI traversing the brainstem-the first case of complete neurological recovery following such injury. Neuroimaging captured the trajectory of the initial injury. A delayed-onset carotid cavernous fistula and the subsequent development of internal carotid artery pseudoaneurysms were managed by endovascular embolization.The authors also review the relevant literature. Sixteen cases of imaging-confirmed PHI traversing the brainstem have been reported, 14 involving the pons and 12 penetrating via the transorbital route. Management and outcome of PHI are informed by object velocity, material, entry point, trajectory, relationship to neurovascular structures, and the presence of a retained foreign body. Trauma resuscitation is followed by a careful neurological examination and appropriate neuroimaging. Ophthalmological examination is performed if transorbital penetration is suspected, as injuries may be occult; the potential for neurovascular complications highlights the value of angiography. The featured case shows that complete recovery is possible following injury that traverses the brainstem.
Collapse
Affiliation(s)
- Mark A MacLean
- 1Dalhousie University, Division of Neurosurgery, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Karim Mukhida
- 2Dalhousie University, Department of Anesthesia, Pain Management & Perioperative Medicine, Halifax, Nova Scotia
| | - Jai J S Shankar
- 3Department of Medicine, Department of Radiology, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba; and
| | - Matthias H Schmidt
- 4Dalhousie University, Division of Diagnostic Radiology, Department of Diagnostic Radiology, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - David B Clarke
- 1Dalhousie University, Division of Neurosurgery, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia
| |
Collapse
|
7
|
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.
Collapse
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
| | | |
Collapse
|
8
|
Sun G, Yagmurlu K, Belykh E, Lei T, Preul MC. Management Strategy of a Transorbital Penetrating Pontine Injury by a Wooden Chopstick. World Neurosurg 2016; 95:622.e7-622.e15. [DOI: 10.1016/j.wneu.2016.07.104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/01/2022]
|
9
|
Foreign body of the brainstem by penetrating injury: Conservative treatment. Neurochirurgie 2015; 61:401-3. [PMID: 26598392 DOI: 10.1016/j.neuchi.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/03/2015] [Accepted: 09/09/2015] [Indexed: 11/23/2022]
Abstract
Traumatic brainstem injuries usually lead to severe lesions and unfavourable outcome. In the literature, the few cases with favourable outcome all benefited from surgical removal of the foreign body. We report a very unusual case of a penetrating brainstem injury with a crossbow arrow with conservative treatment and favourable clinical course despite an infectious complication (brainstem abscess). This case illustrates an important gap between a good clinical status and the severity of the lesion highlighted by CT scan. In addition, a collegial decision was made not to treat the lesion surgically, but only the complication, the abscess, by stereotactic puncture. The treatment must thus be tailored in this type of lesion.
Collapse
|
10
|
Williams JR, Aghion DM, Doberstein CE, Cosgrove GR, Asaad WF. Penetrating brain injury after suicide attempt with speargun: case study and review of literature. Front Neurol 2014; 5:113. [PMID: 25071701 PMCID: PMC4083241 DOI: 10.3389/fneur.2014.00113] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/16/2014] [Indexed: 11/16/2022] Open
Abstract
Penetrating cranial injury by mechanisms other than gunshots are exceedingly rare, and so strategies and guidelines for the management of PBI are largely informed by data from higher-velocity penetrating injuries. Here, we present a case of penetrating brain injury by the low-velocity mechanism of a harpoon from an underwater fishing speargun in an attempted suicide by a 56-year-old Caucasian male. The case raised a number of interesting points in management of low-velocity penetrating brain injury (LVPBI), including benefit in delaying foreign body removal to allow for tamponade; the importance of history-taking in establishing the social/legal significance of the events surrounding the injury; the use of cerebral angiogram in all cases of PBI; advantages of using dual-energy CT to reduce artifact when available; and antibiotic prophylaxis in the context of idiosyncratic histories of usage of penetrating objects before coming in contact with the intracranial environment. We present here the management of the case in full along with an extended discussion and review of existing literature regarding key points in management of LVPBI vs. higher-velocity forms of intracranial injury.
Collapse
Affiliation(s)
- John R Williams
- Warren Alpert School of Medicine, Brown University , Providence, RI , USA
| | - Daniel M Aghion
- Warren Alpert School of Medicine, Brown University , Providence, RI , USA ; Department of Neurosurgery, Rhode Island Hospital , Providence, RI , USA
| | - Curtis E Doberstein
- Warren Alpert School of Medicine, Brown University , Providence, RI , USA ; Department of Neurosurgery, Rhode Island Hospital , Providence, RI , USA
| | - G Rees Cosgrove
- Warren Alpert School of Medicine, Brown University , Providence, RI , USA ; Department of Neurosurgery, Rhode Island Hospital , Providence, RI , USA ; Department of Clinical Neuroscience, Warren Alpert School of Medicine, Brown University , Providence, RI , USA
| | - Wael F Asaad
- Warren Alpert School of Medicine, Brown University , Providence, RI , USA ; Department of Neurosurgery, Rhode Island Hospital , Providence, RI , USA ; Department of Clinical Neuroscience, Warren Alpert School of Medicine, Brown University , Providence, RI , USA ; Brown Institute for Brain Sciences , Providence, RI , USA
| |
Collapse
|