Background and importance: Transorbital penetrating brain injury (PBI) due to a non-projectile foreign body is rare. It can lead to life-threatening severe neurovascular damage. Surgery is the primary treatment choice; however, there are a number of approaches that can be considered based on the patient's condition in terms of foreign body location and state of the patient. Clinical presentation: An 18-year-old male carpenter was hit by a log and sustained transorbital PBI while cutting wood with a machine. Computed tomography (CT) scan showed a wooden spike that was approximately 11 cm from the left medial orbital to the superior part of the posterolateral of the petrous bone, crossing the right side at the base of the skull. CT angiography (CTA), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) revealed no internal carotid artery (ICA) and cavernous sinus lesions, respectively. We had a 3D-printed model for preoperative planning, and surgery was performed using a transorbital approach to extract the wood 14 days after the accident. The impacted wood was removed without any complications. Conclusion: There are many surgical approaches for transorbital PBI. We decided to perform the transorbital approach because it is perpendicular to the entry zone. Surgeons should consistently perform minimally invasive procedures based on the clinical and radiological findings.
Ball bearing (BB) and pellet guns are non-power guns but their related injuries have been reported worldwide. They represent a significant cause of injury especially among children and teenagers. Their potentially harmful and lethal effects have been well documented in the medical literature since the early 1980s. Fatality rate is closely related to the damaged part of the brain and the level of the damage. In this Case Report we documented a 6-years-old girl was getting shot at the head by herself, who initially want to play around, using her neighbour’s Air gun rifle. The pellet trajectory passed through the left frontal lobe, left temporal lobe, left posterior putamen, posteriorly left crus posterior of internal capsule, left occipital horn of lateral ventricle, left occipital lobe, and ended at left cerebral falx between both medial surfaces of occipital lobes. Directional slope of the pellet was medially upward, with its tracking left Intracerebral Hemorrhage (ICH) with perifocal edema and Intraventricular Hemorrhage (IVH) dominant in the left lateral ventricle. After 8 days management, the patient was discharged from our hospital with stable condition, GCS 15 without any significant neurological deficits. Intracranial intracerebral pellet due to air gun shot injury, may have fatal and lethal manifestation if the pellet damage the eloquent area and/or deep area of the brain (hypothalamus, thalamus and brain stem). If accessible the foreign body or pellet should be removed immediately for better outcome. Keywords: Head Injury, Air Gun Shot, Intracerebral Haemorrhage
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