Management of Transorbital Penetrating Intracranial Injury by a Homemade Metal Arrow: Serials Case Report

Eko Prasetyo; Maximillian Christian Oley; Andi Asadul Islam; Prihantono Prihantono

doi:10.3889/oamjms.2020.3361

Authors

Eko Prasetyo Department of Neurosurgery, Neurotrauma Center, School of Medicine, Universitas Sam Ratulangi, RD Kandou Hospital, Manado, Indonesia
Maximillian Christian Oley Department of Neurosurgery, Neurotrauma Center, School of Medicine, Universitas Sam Ratulangi, RD Kandou Hospital, Manado, Indonesia
Andi Asadul Islam Departement of Neurosurgery, School of Medicine, Universitas Hasanuddin, Makassar, Indonesia
Prihantono Prihantono Departement of Neurosurgery, School of Medicine, Universitas Hasanuddin, Makassar, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.3361

Keywords:

homemade metal arrow, transorbital penetrating intracranial injury, traumatic brain injury

Abstract

BACKGROUND: Transorbital penetrating intracranial injury (TOPI) is rare lesions, representing about 0.4% of traumatic brain injury. This uncommon injury has potentially severe and fatalities brain damage with high mortality rate if not promptly treated.

CASE REPORT: We presented three patients with TOPI following penetration by a homemade metal arrow; unfortunately, two patients (cases 1 and 2) death on arrival at our hospital. As a survival patient (case 3), a 15-year-old boy presented with a homemade metal arrow entered through a right superior orbital fissure into the right cerebral hemisphere. Plain skull radiograph showed that the tip of the shaft was located in the right of the posterior cerebral hemisphere and confirmed by computerized tomography (CT) and three-dimensional CT of his brain. Injury to the right middle cerebral arteries was apparent on non-contrast CT angiography. Using a right occipital craniotomy approach with C-arm radiography fluoroscopy guidance, we successfully removed the arrow. Follow-up studies confirmed an excellent outcome.

CONCLUSIONS: Pre-operative imaging is mandatory to evaluate the trajectory, brain, and vascular injury for appropriate surgical planning and post-operative care of patients with TOPI.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Yamaguchi T, Hata H, Hiratsuka H, Suganuma Y, Inaba Y. Penetrating transorbital brain injury and intracranial foreign body(author’s transl). No Shinkei Geka. 1978;6(2):179-84. PMid:634445

Kasamo S, Asakura T, Kusumoto K, Nakayama M, Kadota K, Atsuchi M, et al. Transorbital penetrating brain injury. No Shinkei Geka. 1992;20(4):433-8.

Paiva WS, Saad F, Carvalhal ES, De Amorim RL, Figuereido EG, Teixeira MJ. Transorbital stab penetrating brain injury. Ann Ital Chir. 2009;80(6):463-5. PMid:20476680

Turbin RE, Maxwell DN, Langer PD, Frohman LP, Hubbi B, Wolansky L, et al. Patterns of transorbital intracranial injury: A review and comparison of the occult a non-occult cases. J Survophthal 2006;51(5):449-60. https://doi.org/10.1016/j. survophthal.2006.06.008 PMid:16950246

Gennarelli TA, Champion HR, Sacco WJ, Copes WS, Alves WM. Mortality of patients with a head injury and extracranial injury treated in trauma centers. J Trauma 1989;29(9):1193-201. https://doi.org/10.1097/00005373-198909000-00002 PMid:2769804

Satyarthee GD, Dawar P, Borkar SA, Sharma BS. Trans-orbital penetrating head injury(TOPHI): Short series of two cases with review of the literature. Indian J Neurotrauma. 2014;11:49-52. https://doi.org/10.1016/j.ijnt.2014.12.006

Natrella M, Duc L, Lunardi G, Cristoferi M, Fanelli G, Meloni T. Treatment of a transorbital penetrating injury: A particular endovascular approach. Interv Neuroradiol. 2012;18(2):191-4. https://doi.org/10.1177/159101991201800211

Satyarthee GD, Borkar SA, Tripathi AJ, Sharma BS. Transorbital penetrating cerebral injury with ceramic stone: Report of an interesting case. Neurol India. 2009;57(3):331-3. https://doi. org/10.4103/0028-3886.53285 PMid:19587478

O’Neill OR, Gilliland G, Delashaw JB, Purtzer TJ. Transorbital penetrating head injury with a hunting arrow: A Case report. Surg Neurol. 1994;42(6):494-7. https://doi. org/10.1016/0090-3019(94)90079-5 PMid:7825104

Cato-Addison WB, Demetriades AK, Saker R, Verity DH, Marsh H. Near fatal art-transorbital brain injury. Orbit. 2007;26(4):279-81. https://doi.org/10.1080/01676830601169130 PMid:18097968

Balasubramanian C, Kaliaperumal C, Jadun CK, Dias PS. Transorbital intracranial penetrating injury an anatomical classification. Surg Neurol. 2009;71(2):238-40. https://doi. org/10.1016/j.surneu.2007.07.050 PMid:18291474

Arslan M, Eseoğlu M, Güdü BO, Demir I. Transorbital orbitocranial penetrating injury caused by a metal bar. J Neurosci Rural Prac. 2012;3(2):178-81. https://doi.org/10.4103/0976-3147.98228 PMid:22865972

Lin HL, Lee HC, Cho DY. Management of transorbital brain injury. J Chin Med Assoc. 2007;70(1):36-8. PMid:17276932

Schreckinger M, Orringer D, Thompson G, La Marca F, Sagher O. Transorbital penetrating injury: Case series, review of the literature, and proposed management algorithm. J Neurosurg. 2013;114(1):53-61. https://doi.org/10.3171/2010.8.jns10301 PMid:20868210

Van Duinen, MA. Pathogenesis, clinical presentation, and physical examination. In: van Duinen MA, editors. The Transorbital Intracranial Penetrating Injury. Dordrecht: Springer Science+Business Media; 2000. p. 39-90. https://doi. org/10.1007/978-94-011-4457-5_8

Abdulbaki A, Al-Otaibi F, Almaki A, Alohaly N, Baeesa S. Transorbital craniocerebral occult penetrating injury with cerebral abscess complication. Case Rep Ophthal Med. 2012;2012:742186. https://doi.org/10.1155/2012/742186 PMid:23097729

Park SJ, Chi M. Transorbital penetrating intracranial injury by a battery. J Craniofac Surg. 2018;29(1):e61-4. https://doi. org/10.1097/scs.0000000000004054 PMid:29065045

Gilmour DF, Ramaesh K, Fleck BW. Trans-orbital intra-cranial air gun injury. Eur J Ophthal. 2003;13(3):320-3. https://doi. org/10.1177/112067210301300314

Gupta PK, Thajjuddin BA, Al Sikri NE, Bangroo AK. Penetrating intracranial injury due to crochet needle. Pediatr Neurosurg. 2008;44:493-5. https://doi.org/10.1159/000180306

Awori JA, Wilkinson DA, Gemmete JJ, Thompson BG, Chaudhary N. Penetrating head injury by a nail gun: Case report, review of the literature, and the management considerations. J Stroke Cerebrovas Dis. 2017;26(8):e143-9. https://doi. org/10.1016/j.jstrokecerebrovasdis.2017.04.004 PMid:28551290

Bair RL, Wells RG, Massaro BM, Linder JS, Lewandowski MF, Harris GJ. Imaging in orbital trauma. Semin Ophthal. 1994;9(3):185-92. PMid:10155638

Ram MS, Joshi M, Debnath J, Khanna SK. 3 Dimensional CT Med J Armed Forces India. 1998;54(3):239-42. https://doi. org/10.1016/s0377-1237(17)30553-1 PMid:28775486

Vannier MW, Marsh JL, Warren JO. Three dimensional CT reconstruction images for craniofacial surgical planning and evaluation. Radiology. 1984;150(1):179-84. https://doi. org/10.1148/radiology.150.1.6689758 PMid:6689758

Riley JP, Boucher AB, Kim DS, Barrow DL, Reynolds MR. The role of intraoperative cerebral angiography in transorbital intracranial penetrating trauma: A case report and literature review. World Neurosurg. 2017;97:761e5-10. https://doi. org/10.1016/j.wneu.2016.09.083 PMid:27693768

Sun G, Yagmurlu K, Belykh E, Lei T, Preul MC. Management strategy of transorbital penetrating pontine injury by wooden. World Neurosurg. 2016;95:622.e7-15. https://doi.org/10.1016/j. wneu.2016.07.104 PMid:27506405

Agrawal A, Reddy U, Kumar SS, Hegde V, Rao GM. Transorbital orbitocranial penetrating injury with an iron rod. Craniomaxillofac Trauma Reconstr. 2016;9(2):145-8. https://doi. org/10.1055/s-0035-1551545 PMid:27162571

Paiva WS, Monaco B, Prudente M, Soares MS, de Amorim RL, de Andrade AF, et al. Surgical treatment of transorbital penetrating brain injury. Clin Ophthal. 2010;4:1103-5. https://doi. org/10.2147/opth.s9638 PMid:20957055