2020 Volume 25 Issue 2 Pages 294-300
A transorbital penetrating injury by a foreign body is a rare type of head injury. Here, we report a patient with a transorbital penetrating skull‒base injury caused by the broken blade of a lawn trimmer. A 69‒year‒old male presented to our emergency room with a ruptured right eye globe. A skull X‒ray revealed multiple foreign bodies (metal fragments) in the right orbital region, right buccal cavity, and right frontal lobe. Head computed tomography (CT) revealed an asymptomatic chronic subdural hematoma on the left side and two foreign bodies in the right frontal lobe. Ophthalmologists removed the metal fragments from the orbital cavity, and neurosurgeons then removed the intracranial foreign bodies by right frontotemporal craniotomy. Because the foreign bodies were assumed to be anterior to the insular gyrus, the Sylvian fissure was opened and excised via a retrograde transcortical approach. The intracranial foreign bodies were identified as a bone fragment and a trimmer blade. Fluoroscopy was useful to confirm the location of the intra‒orbital foreign body, and ultrasound helped to identify the location of the intraparenchymal foreign bodies. The patient had an uneventful postoperative course with no sign of meningitis and no seizures. Although transorbital penetrating head injuries are rarely encountered in daily medical practice, it is necessary to have the appropriate system and mindset to treat them promptly when they appear.
