[Transorbital penetrating brain injury].
Transorbital penetrating brain injury is rare during this time of peace. In our paper, we reported seven cases of these injuries and discussed the mechanism and treatment of intracranial complications. Transorbital penetrating brain injuries were caused by thin, long and relative hard objects such as chop-stick (case 3), pencil (case 6), bamboo stick (case 1, 2, 7) and a piece of metal (case 4, 5). CT scan, MRI and angiography demonstrated a large variety of intracranial complications. For instance, intracerebral hematoma, cerebral contusion, intraventricular hemorrhage, pneumocephalus, brain stem injury and carotid cavernous sinus fistula. We had no case of infectious complications such as meningitis and brain abscess. If the direction of the injuring object runs parallel to the orbital roof, it penetrates the cranial cavity commonly via the superior orbital fissure or the optic canal, which routes provide direct access without bone fracture. This direction will cause critical intracranial complications such as CCF or brain stem injury. If the injuring object runs upward and across the orbital roof which has thin bone and therefore offers little resistance, the frontal lobe will be easily damaged, and it will cause intracerebral hematoma. But the prognosis for this type of injury is not so poor because we can easily remove the hematoma and the foreign body. With our treatment policy of "pull and see", all our cases but one recovered well. The one exception was a case in which a large intracerebral hematoma was over-looked in an ophthalmological clinic. This patient died. Nowadays, CT scan and MRI give clear information about the anatomical location of injuring objects and intracranial complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Kasamo
S
S
Department of Neurosurgery, Faculty of Medicine, University of Kagoshima, Japan.
Asakura
T
T
Kusumoto
K
K
Nakayama
M
M
Kadota
K
K
Atsuchi
M
M
Yamamoto
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain; D001930:Brain Injuries / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*