CASE REPORTS   

Journal of Neurosurgical Sciences 1999 September;43(3):229-34

Copyright © 1999 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical treatment of penetrating orbito-cranial injuries. Case report

Domenicucci M., Qasho R., Ciappetta P., Vangelista T., Delfini R.

Chair of Neurotraumatology, University of Rome “La Sapienza”, Rom

Penetrating orbi­tal inju­ries are not fre­quent but nei­ther are they rare. The var­i­ous diag­nos­tic and ther­a­peu­tic prob­lems are relat­ed to the ­nature of the pen­e­trat­ing ­object, its veloc­ity, shape and size as well as the pos­sibil­ity that it may be par­tial­ly or whol­ly ­retained with­in the orbit. The ­authors ­present ­another case with unusu­al char­ac­ter­is­tics and dis­cuss the strat­e­gies avail­able for the best pos­sible treat­ment of this trau­mat­ic pathol­o­gy in the light of the pub­lished data. The ­patient in this case was a young man ­involved in a road acci­dent who pre­sent­ed orbi­to-cere­bral pen­e­tra­tion ­caused by a metal rod with a pro­tec­tive plas­tic cap. Following the acci­dent, the plas­tic cap (2.5×2 cm) was par­tial­ly ­retained in the orbit. At ­initial clin­i­cal exam­ina­tion, dam­age ­appeared to be exclu­sive­ly oph­thal­mo­log­i­cal. Subsequent CT scan dem­on­strat­ed the ­degree of intra­cer­e­bral involve­ment. The dam­aged cere­bral tis­sue was ­removed togeth­er with bone frag­ments via a bifron­tal cran­i­ot­o­my, the for­eign body was extract­ed and the dura ­repaired. Postoperative recov­ery was nor­mal and there were no neuro-oph­thal­mo­log­i­cal def­i­cits at long-term clin­i­cal assess­ment.
Orbito-cra­ni­al pen­e­tra­tion, which is gen­er­al­ly asso­ciat­ed with vio­lent inju­ries ­caused by high-veloc­ity mis­siles, may not be sus­pect­ed in trau­mas pro­duced by low-veloc­ity ­objects. Diagnostic orien­ta­tion large­ly ­depends on pre­cise knowl­edge of the trau­mat­ic event and the ­object respon­sible. When pen­e­tra­tion is sus­pect­ed and/or the ­object respon­sible is inad­e­quate­ly iden­ti­fied, a CT scan is indi­cat­ed. The type of pro­ce­dure to adopt for extrac­tion, ­depends on the size and ­nature of the ­retained ­object.
Although the pos­sibil­ity of non-sur­gi­cal extrac­tion has been ­described, sur­gi­cal remov­al is the saf­est form of treat­ment in cases with exten­sive lac­er­a­tion and brain con­tu­sion.