Transorbital penetrating head trauma leading to serious cerebral edema - A case report

Abstract

Penetrating transorbital head injuries are rarely seen. We present a 6-year old male patient who was referred to our department after a wooden stick penetrated his right eye. On admission his general condition was well and he showed no neurologic deficits. On his cranial computed tomography (CT) there was a fracture on his right orbital wall and minimal subarachnoid hemorrhage in his right frontal lobe. On later follow-ups the patient's condition worsened and his control CT showed diffuse cerebral edema. The patient underwent emergent decompressive surgery. Due to this immediate intervention the patient was released from the hospital with no major deficits later. Up to our knowledge, there are no cases in the literature reported in which decompressive craniectomy was necessary after a transorbital penetrating head trauma.

Fig. 1

Cranial CT on admission, axial view: bone fragment of the displaced right posterior wall and minimal subarachnoid hemorrhage.

Fig. 2

Cranial CT 12 h after admission, axial view: right orbital effusion with parenchymal character.

Fig. 3

a: Cranial CT 12 h after admission, axial view: diffuse cerebral edema. b: Cranial CT 12 h after admission, sagittal view: progression of the subarachnoid hemorrhage.

Fig. 4

Postoperative cranial CT, axial view: frontotemporal decompression with external ventricular drain placement.

Fig. 5

Postoperative cranial CT after cranioplasty, 3D-reconstruction: cranioplasty with autologous bone graft harvested from subcutaneous tissue.