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Transorbital penetrating brain injury to frontal lobe by a wheel spoke.

Ijaz L, Nadeem MM - J Pediatr Neurosci (2014 Sep-Dec)

Bottom Line: A 3.5-year-old girl presented with PBI with a wheel spoke.Computerized tomography scan with three-dimensional skull reconstruction depicted its extent from the medial side of the roof of the right orbit to the right frontal lobe with a cavitation around the spoke.Postoperative outcome was uneventful.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Neurosurgery, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.

ABSTRACT
Penetrating brain injury (PBI) is rare and the severest form of head injury with a high morbidity and mortality. A 3.5-year-old girl presented with PBI with a wheel spoke. Computerized tomography scan with three-dimensional skull reconstruction depicted its extent from the medial side of the roof of the right orbit to the right frontal lobe with a cavitation around the spoke. The spoke was removed by manipulation under general anesthesia from the entry site without a formal craniotomy. Postoperative outcome was uneventful.

No MeSH data available.


Related in: MedlinePlus

Wheel spoke intruded transorbitally. Inset showed postremoval image
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Figure 1: Wheel spoke intruded transorbitally. Inset showed postremoval image

Mentions: A 3.5-year-old girl presented to the surgical emergency with a metal rod intruded to the medial side of the right eye. The mother of this child had died. The incident occurred while she was playing with a bicycle wheel spoke and accidentally fell over it, resulting in penetrating injury [Figure 1]. The patient bled from the entry wound which could not be quantified. The bleeding, however, ceased spontaneously in the meantime when she arrived at us. She was vitally stable with a Glasgow Coma Scale score of 15/15 with no focal neurological deficit. Ophthalmologic examination ruled out an eyeball injury. Skull radiographs in antero-posterior and lateral views revealed angled end of a long wheel spoke penetrating about 10 cm deep into the cranium through the medial aspect of the roof of the right orbit [Figure 2]. The computerized tomography (CT) scan with three-dimensional reconstruction showed the spoke lying in the right frontal lobe (premotor area), the internal trajectory being perpendicular to roof of the orbit, away from brain vasculature and vital centers, and a cavitation around the spoke [Figure 3]. Blood investigations were within normal limits. The patient was taken to the operation theatre after optimization. The entrance wound was extended slightly and spoke pulled back bit by bit. It took half an hour to retrieve the spoke completely. The patient remained vitally stable throughout the procedure. The dural defect was packed with sponge-stone and bone-wax. Peri-orbita and the skin were closed [Figure 1]. Immediate postoperative recovery was uneventful. The patient was allowed orally on the following day of operation and discharged on the 4th postoperative day on antibiotics for 2 weeks. The patient has visited us twice; she is in a good state of health without any signs of local and central nervous system infections and cerebrospinal fluid (CSF) leakage.


Transorbital penetrating brain injury to frontal lobe by a wheel spoke.

Ijaz L, Nadeem MM - J Pediatr Neurosci (2014 Sep-Dec)

Wheel spoke intruded transorbitally. Inset showed postremoval image
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4302551&req=5

Figure 1: Wheel spoke intruded transorbitally. Inset showed postremoval image
Mentions: A 3.5-year-old girl presented to the surgical emergency with a metal rod intruded to the medial side of the right eye. The mother of this child had died. The incident occurred while she was playing with a bicycle wheel spoke and accidentally fell over it, resulting in penetrating injury [Figure 1]. The patient bled from the entry wound which could not be quantified. The bleeding, however, ceased spontaneously in the meantime when she arrived at us. She was vitally stable with a Glasgow Coma Scale score of 15/15 with no focal neurological deficit. Ophthalmologic examination ruled out an eyeball injury. Skull radiographs in antero-posterior and lateral views revealed angled end of a long wheel spoke penetrating about 10 cm deep into the cranium through the medial aspect of the roof of the right orbit [Figure 2]. The computerized tomography (CT) scan with three-dimensional reconstruction showed the spoke lying in the right frontal lobe (premotor area), the internal trajectory being perpendicular to roof of the orbit, away from brain vasculature and vital centers, and a cavitation around the spoke [Figure 3]. Blood investigations were within normal limits. The patient was taken to the operation theatre after optimization. The entrance wound was extended slightly and spoke pulled back bit by bit. It took half an hour to retrieve the spoke completely. The patient remained vitally stable throughout the procedure. The dural defect was packed with sponge-stone and bone-wax. Peri-orbita and the skin were closed [Figure 1]. Immediate postoperative recovery was uneventful. The patient was allowed orally on the following day of operation and discharged on the 4th postoperative day on antibiotics for 2 weeks. The patient has visited us twice; she is in a good state of health without any signs of local and central nervous system infections and cerebrospinal fluid (CSF) leakage.

Bottom Line: A 3.5-year-old girl presented with PBI with a wheel spoke.Computerized tomography scan with three-dimensional skull reconstruction depicted its extent from the medial side of the roof of the right orbit to the right frontal lobe with a cavitation around the spoke.Postoperative outcome was uneventful.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Neurosurgery, The Children's Hospital and the Institute of Child Health, Lahore, Pakistan.

ABSTRACT
Penetrating brain injury (PBI) is rare and the severest form of head injury with a high morbidity and mortality. A 3.5-year-old girl presented with PBI with a wheel spoke. Computerized tomography scan with three-dimensional skull reconstruction depicted its extent from the medial side of the roof of the right orbit to the right frontal lobe with a cavitation around the spoke. The spoke was removed by manipulation under general anesthesia from the entry site without a formal craniotomy. Postoperative outcome was uneventful.

No MeSH data available.


Related in: MedlinePlus