Minimally Invasive Subtemporal Intradural Approach for Penetrating Orbitocranial Injury by Wooden Foreign Body Into the Lateral Wall of the Cavernous Sinus

Elad Avraham, Alexander Smolikov, Rozalia Smolyakov, Amit Azriel, Yuval Sufaro, Tehila Kaisman-Elbaz, Gregory Zlatin, Israel Melamed

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Non-missile transorbital penetrating head injuries are relatively rare, though potentially fatal injuries. Trajectory for intracranial entrance is typically via the orbital roof, the superior orbital fissure (SOF), or the optic canal. Non-metallic intracranial penetrating injuries are even scarcer and may pose unusual diagnostic and surgical challenges. Here we present and discuss a unique case of a penetrating injury by a wooden foreign body (FB) which entered and expanded the inter-dural space of the lateral cavernous sinus (CS) sinus wall without intracavernous or intradural involvement. The patient was a 71 year-old male who fell face-down and sustained a penetrating transorbital injury by a dry twig fragment, which passed through the SOF and into the interdural space of lateral wall of the ipsilateral CS. The patient was fully conscious (GCS15) at presentation but had severe ocular injury (complete ophthalmoplegia and blindness of the injured eye). The wooden FB was successfully removed via a minimally invasive subtemporal intradural approach with no apparent immediate or long-term complications. We emphasize the unusual diagnostic and surgical challenges related to this kind of rare injuries as reflected by the decision-making considerations taken in the presented case.

Original languageEnglish
Article number533567
JournalFrontiers in Surgery
Volume7
DOIs
StatePublished - 22 Sep 2020
Externally publishedYes

Keywords

  • cavernous sinus
  • minimally invasive
  • orbitocranial injury
  • penetrating injury
  • subtemporal approach
  • wooden foreign body

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