Guozhu Sun1, Kaan Yagmurlu2, Evgenii Belykh3, Ting Lei2, Mark C Preul4. 1. Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. 2. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. 3. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Department of Neurosurgery, Irkutsk State Medical University, Russian Federation. 4. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.
Abstract
BACKGROUND: Transorbital penetrating pontine injuries from small spear-like objects, which are extremely rare, provide neurosurgeons with life-threatening and challenging conditions to manage. CASE DESCRIPTION: We present an unusual case of transorbital penetrating pontine injury and discuss imaging, diagnosis, management strategy, and anatomy-injury correlation. A 23-year-old man sustained a penetrating cranial injury from a bamboo chopstick that extended from the right orbit to the pons and cerebellum. Using a frontotemporal approach, we successfully removed the chopstick. Follow-up studies confirmed a good outcome. CONCLUSIONS: Preoperative imaging, correct diagnosis, and surgical treatment are necessary to manage transorbital penetrating pontine injuries caused by spear-like objects, with specific attention paid to effective exposure and inventive means with total removal of the foreign object without causing further injury. A trajectory through the superior orbital fissure and paralateral to the cavernous sinus and into the pons seems to be the most prevalent and influences management of removal and injuries.
BACKGROUND: Transorbital penetrating pontine injuries from small spear-like objects, which are extremely rare, provide neurosurgeons with life-threatening and challenging conditions to manage. CASE DESCRIPTION: We present an unusual case of transorbital penetrating pontine injury and discuss imaging, diagnosis, management strategy, and anatomy-injury correlation. A 23-year-old man sustained a penetrating cranial injury from a bamboo chopstick that extended from the right orbit to the pons and cerebellum. Using a frontotemporal approach, we successfully removed the chopstick. Follow-up studies confirmed a good outcome. CONCLUSIONS: Preoperative imaging, correct diagnosis, and surgical treatment are necessary to manage transorbital penetrating pontine injuries caused by spear-like objects, with specific attention paid to effective exposure and inventive means with total removal of the foreign object without causing further injury. A trajectory through the superior orbital fissure and paralateral to the cavernous sinus and into the pons seems to be the most prevalent and influences management of removal and injuries.
Authors: Tengyue Huang; Jun Ling; Ming Liu; Chuanzhen Qiu; Guanfu Ding; Jun Huang; Boris Krischek; Shaochun Yang; Feng Zheng Journal: J Int Med Res Date: 2019-12-16 Impact factor: 1.671