Skull Base Penetration Due to Cervical Impalement Injury: A Case Report and Review of the Literature

Abstract

Impalement injury is a rare type of trauma, and the management should be performed carefully. In cases with impalement injuries, the area of injury and crush might be extensive because the penetrating object itself is generally large and long. Herein, we report our experience with a rare case of cervical impalement injury caused by an iron reinforcing bar penetrating the optic canal and thereby causing brain contusion. A 32-year-old man fell while working at a construction site and sustained an injury due to an iron reinforcing bar that penetrated his right neck. On arrival at the hospital, consciousness was clear and the bar was removed by himself. The patient had lost the sight in his right eye, and cerebrospinal fluid (CSF) rhinorrhea was present. Based on the results of computed tomography (CT) of the head and neck, the bar was thought to have passed through the right mandible and the right optic canal and penetrated the frontal lobe. Surgical repair of frontal base was performed using femoral fascia, completely stopping the CSF leak. The patient was discharged on the 31st hospital day walking independently. In our present case, the top of a foreign body was reached an intracranial site. Impalement injuries require detailed assessment of the injury sites because outcomes depend on the severity of injuries at surrounding anatomical structures. Multiple planar reconstruction using recent multidetector row CT scanning was considered to be useful for the assessment of penetrating routes and injury severity.