title: Orbitocranial Low-Velocity Penetrating Injury: A Personal Experience, Case Series, Review of the literature, and Proposed Management Plan.
abstract: BACKGROUND
  Orbitocranial penetrating injuries (OPI) are an unfamiliar subset of head injury and are particularly rare in clinical practice. They are usually the result of falls or motor vehicle collisions and occur more commonly in children, who are prone to trauma while playing games improperly.
  
  
  METHODS
  We present a retrospective review of 5 cases of OPI treated in the Neurotrauma Department at Xiangya Hospital of Central South University in the last 5 years. Also, we performed comprehensive literature searches using Web of Science and the terms "orbitocranial injury," "penetrating ocular trauma," "penetrating orbital trauma," and "transorbital chopstick penetrating injury" to search for presentation, mechanism of injury, and management of transorbital penetrating injury.
  
  
  RESULTS
  In 2 patients, there was right internal carotid artery occlusion while in other 2 patients, the penetrating objects reached the brainstem through the cavernous sinus, resulting in orbital apex syndrome. All patients underwent a thorough physical examination followed by diagnostic imaging. The cases were successfully managed surgically by removing the foreign bodies through their trajectories.
  
  
  CONCLUSIONS
  Computed tomography, magnetic resonance imaging, and computed tomography angiography are key imaging modalities that are frequently used to determine the course of the foreign object and the extent of brain tissue injury as well as to rule out vascular injury in these types of cases. Early surgical exploration by a multidisciplinary team approach is essential to attain good recovery and a favorable outcome.
authors.affiliation: Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Neurosurgery, Muhimbili Orthopedic and Neurosurgical Institute, Dar es salaam, Tanzania.
authors.forename: Juma M
authors.initials: JM
authors.lastname: Mzimbiri
authors.affiliation: Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Mdaish A
authors.initials: MA
authors.lastname: Bajawi
authors.affiliation: Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Song
authors.initials: S
authors.lastname: Lan
authors.affiliation: Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Fenghua
authors.initials: F
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China. Electronic address: 1427822007@qq.com.
authors.forename: Jinfang
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000209:etiology; D001933:Brain Stem / Q000293:injuries; D002343:Carotid Artery, Internal / Q000473:pathology; D002426:Cavernous Sinus / Q000293:injuries; D002533:Cerebral Angiography; D002675:Child, Preschool; D002681:China; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D017809:Fatal Outcome; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000293:injuries* / Q000601:surgery; D012886:Skull / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Brainstem; Cavernous sinus; Cerebral angiography; Chopstick; ICA occlusion; Orbital apex syndrome; Transorbital penetrating injury