A Case Report of a Transorbital Penetrating Intracranial Injury from a Motorcycle Side Mirror Metal Bar
Kia Charisse D. de Asis MD1, Mark Anthony T. Imperial MD DPBO1,2
1University of the East Ramon Magsaysay Memorial Medical Center, Quezon City
2Asian Hospital and Medical Center, Muntinlupa City
Correspondence: Kia Charisse D. de Asis, MD
Clinic Address: University of the East Ramon Magsaysay Memorial Medical Center
Clinic Phone Number: (02) 8715-0861
Email Address: firstname.lastname@example.org
Disclosure: The authors have no financial disclosures or conflicts of interest to declare in relation to this case report.
Objective: To present a case of transorbital penetrating intracranial injury successfully managed using a
stepwise multispecialty approach.
Methods: This is a case report.
Results: A 26-year-old male presented with a motorcycle side-mirror metal bar impaled into his right orbit. He had a Glasgow Coma Scale (GCS) score of 12. Computed tomography (CT) imaging revealed the metal bar’s trajectory from the right lateral canthus, traversing the superior orbital wall and frontal lobe, resulting in contusion, intracranial hemorrhages and multiple orbital and facial fractures. Despite the severity of the injury, the right globe was found to be intact during intraoperative exploration. The transorbital approach was employed for safe removal of the penetrating object, followed by repair of full-thickness eyelid laceration and transections of the lateral and medial canthi. Subsequently, the Neurosurgery service conducted a right pterional craniotomy, debridement, and duraplasty. Upon discharge, the visual acuity on the right eye was 20/50.
Conclusion: Transorbital penetrating intracranial injuries are rare and result in vision loss and life-threatening complications. A transorbital approach in removing a penetrating foreign body can be adopted when injury to cerebral tissues is imminent. Individualizing the management and employing a multispecialty approach can lead to favorable outcomes.
Keywords: Metal bar, intraorbital foreign body, transorbital injury, orbitocranial injury, penetrating trauma