Cerebrovascular complications of transorbital penetrating intracranial injuries

Arat, Yonca Özkan; Arat, Anıl; Aydın, Kubilay

doi:10.5505/tjtes.2015.48839

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…Another possible trajectory for an orbitocranial penetrating object is the superior orbital fissure, with possible damage to the cavernous sinus, producing its thrombosis or rarely a carotid-cavernous fistula. The less common access is through the optic canal with possible injuries to the optic nerve, the ophthalmic artery and the ICA,[ 8 ] as occurred in our case. Consequently, imprudent manoeuvres to extract the foreign body in nonhospital environments can be catastrophic due to the possibility that the object may plug an injured vessel.…”

Section: Discussionmentioning

confidence: 92%

“…[ 7 ] Injuries of intracranial vessels by nonmissile orbitocranial penetrating objects are extremely rare. [ 8 ] Damage to these vital structures can occur as a direct consequence of the foreign body or during the removal of the penetrating object. In case of documented intracranial vessel injury, it is essential to perform a prompt and combined endovascular and open approach to save the patient’s life and reduce possible sequelae.…”

Section: Introductionmentioning

confidence: 99%

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Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report

Tewfik¹,

Covelli

Rossini³

et al. 2022

Annals of Maxillofacial Surgery

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Rationale: Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections. Patient Concerns: We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve. Diagnosis: Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery. Treatment: Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments. Outcomes: Left eye vision was lost. The 1-year follow-up was uneventful. Take-away Lessons: Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report

Tewfik¹,

Covelli

Rossini³

et al. 2022

Annals of Maxillofacial Surgery

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show abstract

“… 18 For example, two patients underwent extravascular common carotid artery occlusion to prevent ICA bleeding. According to different vessel lesions, various endovascular means, such as selective occlusion with balloons or coils and placement of stents or stent-grafts, can be utilized, 19 , 20 with the advantages of lowering the rates of procedure-associated morbidity and mortality. 21 Moreover, endovascular techniques could also be applied in vascular complications, such as arteriovenous fistula and traumatic intracranial aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Trans-base and trans-vault low-velocity penetrating brain injury: A retrospective comparative study of characteristics, treatment, and outcomes

Chen

et al. 2021

Chinese Journal of Traumatology

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Purpose Low-velocity penetrating brain injury (LVPBI) caused by foreign bodies can pose life-threatening emergencies. Their complexity and lack of validated classification data have prevented standardization of clinical management. We aimed to compare the trans-base and trans-vault phenotypes of LVPBI to help provide guidance for clinical decision-making of such injury type. Methods A retrospective study on LVPBI patients managed at our institution from November 2013 to March 2020 was conducted. We included LVPBI patients admitted for the first time for surgery, and excluded those with multiple injuries, gunshot wounds, pregnancy, severe blunt head trauma, etc. Patients were categorized into trans-base and trans-vault LVPBI groups based on the penetration pathway. Discharged patients were followed up by outpatient visit or telephone. The data were entered into the Electronic Medical Record system by clinicians, and subsequently derived by researchers. The demography and injury characteristics, treatment protocols, complications, and outcomes were analyzed and compared between the two groups. A t -test was used for analysis of normally distributed data, and a Mann-Whitney U test for non-parametric data. A generalized linear model was further established to determine whether the factors length of stay and performance scale score were influenced by each factor. Results A total of 27 LVPBI patients were included in this analysis, comprised of 13 (48.1%) trans-base cases and 14 (51.9%) trans-vault cases. Statistical analyses suggested that trans-base LVPBI was correlated with deeper wounds; while the trans-vault phenotype was correlated with injury by metal foreign bodies. There was no difference in Glasgow Coma Scale score and the risk of intracranial hemorrhage between the two groups. Surgical approaches in the trans-base LVPBI group included subfrontal ( n = 5, 38.5%), subtemporal ( n = 5, 38.5%), lateral fissure ( n = 2, 15.4%), and distal lateral ( n = 1, 7.7%). All patients in the trans-vault group underwent a brain convex approach using the foreign body as reference ( n = 14, 100%). Moreover, the two groups differed in application prerequisites for intracranial pressure monitoring and vessel-related treatment. Trans-base LVPBI was associated with higher rates of cranial nerve and major vessel injuries; in contrast, trans-vault LVPBI was associated with lower functional outcome scores. Conclusion Our findings suggest that trans-base and trans-vault LVPBIs differ in terms of characteristics, treatment, and outcomes. Further understanding of these differences may help guide clinical decisions and contribute to a better management of LVPBIs.

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“…Due to the technological limitations at that time, we could perform only DSA in the hybrid operating room. As an effective and low-injury means of vascular occlusion, endovascular techniques can be a better solution than CCA exposure, such as temporary balloon occlusion or stent implantation (22).…”

Section: Discussionmentioning

confidence: 99%

Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review

Chen

Yuan

et al. 2020

Front. Neurol.

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Cerebrovascular complications of transorbital penetrating intracranial injuries

Cited by 8 publications

References 32 publications

Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report

Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report

Trans-base and trans-vault low-velocity penetrating brain injury: A retrospective comparative study of characteristics, treatment, and outcomes

Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review

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