Neurosurgical management uncommon transorbital penetrating brain injury in children

Abstract

Objective − To evaluate the optimal neurosurgical treatment of rare paediatric transorbital penetrating brain injuries.

Case report − A 6 year-old male patient was admitted to the Department of Emergency Medicine of Zenica Cantonal Hospital, Bosnia and Herzegovina, be- cause of an injury to the right eye caused by a knife. The patient was fully conscious, oriented, hemodynamically stable and without any neurological deficit and with a Glasgow Coma Scale score of 15. Computed Tomography showed a knife blade entering the right orbital roof and the medial part of the right frontal lobe, with an underlying tract hematoma. The patient underwent bifrontal craniotomy. The knife was removed carefully. There were no signs of vascular or related injuries on the trajectory. After surgery, the eye was examined by an ophthalmologist. The patient recovered fully and was discharged about ten days after surgery.

Conclusion − Early surgery with a multidisciplinary approach is indicated in patients with transorbital penetrating brain injury to prevent serious complications. The outcome depends on the type of object, the point of entry, the trajectory, the extent of parenchymal injury, the presence of vascular injury, adequate dural closure and septic complications.

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