Minimally invasive treatment of transorbital penetrating injury of skull base and cavernous sinus – A case report

Bojan Jelača; Djula Djilvesi; Vladimir Papić; Filip Pajičić; Milan Lepić; Petar Vuleković

doi:10.2298/VSP200529106J

Bojan Jelača University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0003-3243-3196
Djula Djilvesi University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0003-3131-7855
Vladimir Papić University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0001-6355-2417
Filip Pajičić University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
Milan Lepić Military Medical Academy, Department of Neurosurgery, Belgrade, Serbia
Petar Vuleković University Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia https://orcid.org/0000-0001-8406-8923

DOI: https://doi.org/10.2298/VSP200529106J

Keywords: decompression, surgical;, head injuries, penetrating;, minimally invasive surgical procedures;, neurosurgical procedures.

Abstract

Introduction. A transorbital intracranial injury with a foreign body can be a very complex and controversial therapeutic problem. The orbit's content is susceptible to penetrating trauma, and neurovascular skull base structures are at high risk from injury. There are some traditional cranial surgical approaches and more recently reported different endoscopic approaches for treating this kind of injury. Case report. We presented a case of a 30-year-old male who had an accident at work when a piece of wood hit him in his head and entered through the medial aspect of his left orbit with skull base and cavernous sinus injury. Rapid and complete radiological and clinical assessments were performed, and the patient was treated in a minimally invasive manner. The foreign body was manually extracted with an endoscopic and endovascular team ready to treat adverse events. No postoperative complications were reported, and visual acuity increased at the one-month follow-up. Conclusion. Penetrating wounds of the orbit represent a challenge that requires a multidisciplinary assessment and well-organized management. Combined endoscopic minimally invasive approaches should be considered during the treatment of this kind of injury.

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