title: The surgical management of a penetrating orbitocranial injury with a bakelite foreign body reaching the brain stem.
abstract: BACKGROUND
  Penetrating orbital injuries constitute a significant threat to ocular and cerebral structures. The incidence of central nervous system damage from orbital injury is related to the orbital anatomy and the characteristics of the penetrating object. Penetrating orbital injuries involving the brain stem are extremely rare.
  
  
  OBJECTIVE
  To present an uncommon case of penetrating orbital injury and to discuss surgical management.
  
  
  METHODS
  A patient suffered from a penetrating injury by a Bakelite comb which extended from his left orbit through the cavernous sinus to the pons. Complete occlusion of the left cavernous segment of the internal carotid artery was detected and a frontotemporal craniotomy with lateral superior orbitotomy was performed to remove the object. A delayed asymptomatic carotid-cavernous fistula was identified 1 year later.
  
  
  CONCLUSIONS
  Surgical treatment remains the mainstay of intervention for penetrating orbitocranial injuries. The rationale of surgical removal of a foreign body should focus on safe exposure and removal of the object at the earliest without inflicting further injuries. Close follow-up for a delayed carotid-cavernous fistula is necessary.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
authors.forename: Feifan
authors.initials: F
authors.lastname: Xu
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Li
authors.forename: Shengjun
authors.initials: S
authors.lastname: Sun
authors.forename: Eran
authors.initials: E
authors.lastname: Guo
authors.forename: Shuyu
authors.initials: S
authors.lastname: Hao
authors.forename: Zonggang
authors.initials: Z
authors.lastname: Hou
authors.forename: Gilberto Ka Kit
authors.initials: GK
authors.lastname: Leung
authors.forename: Baiyun
authors.initials: B
authors.lastname: Liu
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000503:physiopathology*; D001766:Blindness; D001933:Brain Stem / Q000293:injuries / Q000503:physiopathology*; D003399:Craniotomy / Q000379:methods*; D005547:Foreign Bodies / Q000601:surgery*; D020197:Head Injuries, Penetrating / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009915:Orbit / Q000293:injuries / Q000601:surgery*; D010969:Plastics; D016896:Treatment Outcome
chemical_list: D010969:Plastics; C006682:bakelite