Early removal of transorbital penetrating traumatic brain injury by a wooden object: a case report

Introduction and importance: Transorbital penetrating traumatic brain injury (TPTBI) is a rare cause of penetrating head injury, yet the diagnoses can be overlooked in some cases due to incomplete history, trivial trauma, and the absence of immediate neurologic deficits.

Case presentation: A 4-year-old male child was admitted with a diagnosis of TPTBI by a wooden object. Noncontrast enhanced CT scan revealed a linear hypodense structure extending from the superior wall of the right orbit into the frontal lobe with displaced fragments into the brain. Additionally, cerebral contusion, pneumocephalus, and hematoma with surrounding edema were seen in the frontal lobe. Early extraction of the foreign body was performed by a multidisciplinary team of neurosurgeons and ophthalmologists. The wooden fragment of size 10 cm×1 cm×1 cm was removed by a small mini-craniotomy of the right frontal supraorbital bone with the gentle pulling of it through the dura mater and frontal cortex. The postoperative course was uncomplicated, vision was restored, and there were no neurologic deficits at the time of discharge on the seventh postoperative day with good postoperative outcomes.

Clinical discussion: Delayed removal of TPTBI may be complicated by misidentification of entry points, extensive scarring around the foreign body, adherence to the intracranial vessels, and increasing mortality due to infectious complications. Therefore, early exploration with the help of a multidisciplinary team will most likely result in successful debridement, good neurologic outcomes, and lower morbidity and mortality.

Conclusion: Accurate diagnosis and early intervention for TPTBI may prevent possible infectious and neurologic complications.