Percutaneous endoscopic removal of a residual foreign body at the orbital-cranial region after transorbital penetrating
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˖ӧӝߥ͗ᇷፂܰመߥѫ͗ CHINESE NEUROSURGICAL SOCIETY
CHINESE MEDICAL ASSOCIATION
CASE REPORT
Open Access
Percutaneous endoscopic removal of a residual foreign body at the orbital-cranial region after transorbital penetrating injury: a novel minimally invasive technique Ying Yao1†, Fang Shen2†, Aiqin Chen1, Guangyu Ying1 and Yongjian Zhu1*
Abstract Background: The orbit is susceptible to traumatic injuries, and surgical management of transorbital penetrating injury with foreign body retention is challenging due to the associated risks of nervous and vascular injury. Application of multiple imaging modalities is helpful for the preoperative surgical planning, and technical advances in percutaneous endoscopy would render the surgical approach even less invasive. Case presentation: We present a 60-year-old female patient with a transorbital penetrating injury (TPI) caused by a bamboo stick in her right eye. The bamboo stick was initially pulled out at the emergency room but, 1 month later, massive bleeding from her nose and mouth occurred. CT and CTA revealed a foreign body in the right orbito-cranial region and a traumatic aneurysm at the right internal carotid artery. Endovascular embolization was first delivered to treat the aneurysm, and the remains of the bamboo stick were completely removed with a percutaneous endoscope. The patient was discharged 1 week later. Conclusions: A careful preoperative examination by multiple imaging modalities, e.g., CT, MRI, and DSA are essential for the correct diagnosis and surgical planning for the patient with a TPI. We minimised the associated risks of vascular and nervous injuries during foreign body removal by sequential application of the endovascular intervention and percutaneous endoscopic technique. Keywords: Wooden foreign body, Percutaneous endoscope, Transorbital penetrating injury
Background Although transorbital penetrating injury (TPI) is relatively rare among head injuries, it constitutes a remarkable proportion of penetrating head injury cases, especially in children. Various objects have been reported to penetrate the low resistance orbital corridors and, depending on the velocity of the impacts, they can either penetrate intracranially or confined within the orbit, causing complications of different severities. Physical examination on the affected orbital region is not accessible because of the presence of periorbital soft-tissue swelling and therefore radiological imaging, such as computed tomography (CT) and * Correspondence: [email protected] † Equal contributors 1 Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China Full list of author information is available at the end of the article
magnetic resonance imaging (MRI), is necessary for the assessment of the extent of injury, identification of intraorbital foreign bodies, accurate diagnoses and guiding appropriate treatment. CT angiography (CTA) and digital subtraction angiography (DSA) could be further performed in cases with evidence of vascular
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