Book review

https://doi.org/10.20471/acc.2022.61.03.21

Surgical Management of a Penetrating Brain Wound and Associated Perforating Ocular Injury Caused by a Low-Velocity Sharp Metallic Object: A Case Report and Literature Review

Bruno Splavski orcid.org/0000-0002-4483-9364 ; Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; J. J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia
Renata Iveković orcid.org/0000-0002-7680-9733 ; Department of Ophthalmology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Bošnjak ; Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Brano Splavski Jr ; Department of Ophthalmology, University Hospital, Antwerp, Belgium
Ante Rotim ; Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Krešimir Rotim ; Department of Neurosurgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; J. J. Strossmayer University of Osijek Faculty of Medicine, Osijek, Croatia; University of Applied Health Sciences, Zagreb, Croatia

Abstract

Penetrating traumatic brain injury accompanied by perforating ocular injury
caused by low-velocity foreign bodies is a life-threatening condition, a surgical emergency and a major
challenge in surgical practice, representing a severe subtype of non-missile traumatic brain injury,
which is a relatively rare pathology among civilians. Optimal management of such an injury remains
controversial, requiring full understanding of its pathophysiology and a multidisciplinary expert approach.
Herein, we report a case of penetrating brain and associated perforating eye injury and discuss
relevant literature providing further insight into this demanding complex multi-organ injury. We
present a case of 39-year-old male patient with transorbital penetrating brain and perforating ocular
injury undergoing emergency surgery to remove a retained sharp metallic object from the left parietal
lobe. Following appropriate and urgent diagnostics, a decompressive left-sided fronto-temporo-parietal
craniectomy was immediately performed. A retained sharp metallic object (a slice of a round saw)
was successfully removed, while primary left globe repair and palpebral and fornix reconstruction were
performed afterwards by an ophthalmologist. A prophylactic administration of broad-spectrum antibiotics
was applied to prevent infectious complications. Early postoperative recovery was uneventful.
The patient was discharged on day 45 post-injury having moderate right-sided motor weakness, ipsilateral
facial nerve central palsy, and light motoric dysphasia. The vision to his left eye was completely
and permanently lost. In conclusion, management of non-missile transorbital penetrating brain injury
can be satisfactory when proper clinical and radiologic evaluation, and amply, less radical surgical
approach is performed early. A multidisciplinary routine is a prerequisite in achieving a favorable
management outcome.

Keywords

Penetrating Traumatic Brain Injury; Transorbital; Perforating Ocular Injury; Low-velocity Non-missile Injury; Retained Foreign Bodies; Surgical Management; Outcome

Hrčak ID:

296219

URI

https://hrcak.srce.hr/296219

Publication date:

1.11.2022.

Article data in other languages: croatian

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