Removal of a Penetrating Tree Branch in the Orbitofrontal Region—A Unique Application of an Orbitofrontal Craniotomy Through a Supraciliary Brow Approach

2021 ◽  
Author(s):  
Rupen Desai ◽  
Anja I Srienc ◽  
Robi N Maamari ◽  
Philip L Custer ◽  
David K Warren ◽  
...  
Keyword(s):  
Foreign Body ◽  
Frontal Lobe ◽  
Antimicrobial Therapy ◽  
Ocular Motility ◽  
Dural Defect ◽  
Ct Angiogram ◽  
Eyebrow Incision ◽  
Tree Branch ◽  
Neurologically Intact ◽  
Unique Application

Abstract BACKGROUND AND IMPORTANCE Orbitocranial penetrating injury (OPI) is associated with neurological, infectious, and vascular sequalae. This report describes unique application of an orbitofrontal craniotomy through a supraciliary approach to remove a wooden stick penetrating through the orbit and frontal lobe, postoperative management, and antimicrobial therapy. CLINICAL PRESENTATION A 51-yr-old male presented after a tree branch penetrated beneath his eye. He had no loss of consciousness and was neurologically intact with preserved vision and ocular motility. Computed tomography (CT) and CT angiogram revealed an isodense hollow cylindrical object penetrating though the left orbit and left frontal lobe. The object extended into the right lateral ventricle, abutting the left anterior cerebral artery. There was minimal intraventricular hemorrhage without arterial injury. The patient was treated with broad-spectrum antimicrobial coverage. The foreign body was removed and the dural defect repaired via an orbitofrontal craniotomy through a supraciliary eyebrow incision. He was treated with an extended course of antimicrobial therapy, and after 18 mo remained neurologically intact. CONCLUSION OPI are a subset of penetrating brain injuries with potential for immediate injury to neurovascular structures and delayed complications including cerebrospinal fluid leak and infection. Treatment includes attempted complete removal of the foreign body and antimicrobial therapy. An orbitofrontal craniotomy through a supraciliary eyebrow incision may be effective in selected patients.

Intraorbital Wooden Foreign Body with Intracranial Extension : A Case Report

2018 ◽  
Vol 44 (1) ◽  
pp. 4
Author(s):  
Amanda N Shinta ◽  
Purjanto Tepo Utomo ◽  
Agus Supartoto
Keyword(s):  
Visual Acuity ◽  
Foreign Body ◽  
Frontal Lobe ◽  
Vital Sign ◽  
Intracranial Extension ◽  
Ocular Motility ◽  
Light Perception ◽  
Bone Segment ◽  
Wooden Foreign Body ◽  
Wooden Stick

Purpose : The aim of this study is to report a case of intraorbital wooden foreign body with intracranial extension to the frontal lobe and its management. Method : This is a descriptive study: A 53 year-old male referred due to wooden stick stucked in the orbital cavity causing protruding eyeball and vital sign instability. Result : Right eye examination revealed light perception visual acuity, with bad light projection and bad color perception, inwardly folded upper eyelid, proptosis, conjunctival chemosis, corneal erosion and edema, dilated pupil with sluggish pupillary light reflex and limited ocular movement in all direction. Vital sign was unstable with decreasing blood pressure, increasing temperature and heart rate. CT Scan showed complete fracture of the orbital roof due to penetration of the wooden stick, pneumoencephalus, cerebral edema and hematoma. Emergency craniotomy was performed to remove the penetrating wooden stick and bone segment in the frontal lobe and fracture repair. Ophthalmologist pulled the remaining stick, released the superior rectus muscle and repaired the lacerated eyelid. Outcome visual acuity was no light perception with lagophthalmos and limited ocular motility. Patient was admitted to Intensive Care Unit one day post-operatively and treated with systemic and topical antibiotic. Conclusion : Any case presenting with intraorbital foreign body must undergo immediate neuroimaging to exclude any intracranial extension, especially in patients with worsening general condition.

scholarly journals Allergic Fungal Sinusitis with Intracranial Extension and Frontal Lobe Symptoms: A Case Report

1994 ◽  
Vol 73 (6) ◽  
pp. 402-404 ◽  
Author(s):  
William M. Lydiatt ◽  
Anne Sobba-Higley ◽  
James V. Huerter ◽  
Lyal G. Leibrock
Keyword(s):  
Case Report ◽  
Brain Injury ◽  
Frontal Lobe ◽  
Surgical Approach ◽  
Cerebral Spinal Fluid ◽  
Intracranial Extension ◽  
Fungal Sinusitis ◽  
Dural Defect ◽  
Allergic Fungal Sinusitis ◽  
Bony Destruction

This is the first report of AFS which caused frontal lobe symptomatology and which resolved with surgical therapy. The surgical approach used provided excellent exposure and the sinuses could be examined and thoroughly cleaned both from above and intranasally. The dural defect, which resulted from the destruction of the cribiform and fovea ethmoidalis, was easily reconstructed with a pericranial flap. This exposure facilitates debridement and reconstruction while minimizing complications such as cerebral spinal fluid leakage or brain injury which may occur with endoscopic manipulations in patients with bony destruction and loss of normal landmarks.

Biologically inert synthetic dural substitutes

1990 ◽  
Vol 73 (6) ◽  
pp. 936-941 ◽  
Author(s):  
Damianos E. Sakas ◽  
Komporn Charnvises ◽  
Lawrence F. Borges ◽  
Nicholas T. Zervas
Keyword(s):  
Foreign Body ◽  
Cerebrospinal Fluid Leak ◽  
Dural Defect ◽  
Artificial Membranes ◽  
Content Type ◽  
Dural Graft ◽  
Polyurethane Film ◽  
Foreign Body Reactions ◽  
Fluid Leak ◽  
Carbonate Film

✓ Two types of artificial membranes, a medical-grade aliphatic polyurethane and a polysiloxane-carbonate block copolymer, were tested as substitutes for dura in 24 and 12 rabbits, respectively. The films were placed either epidurally, subdurally, or as dural grafts in equal subgroups of animals. The postoperative course was uneventful with no manifestations of convulsive disorder or cerebrospinal fluid leak. The animals were sacrificed 3, 6, or 9 months after implantation of the artificial membranes. Both types of artificial membranes were easily removed from the underlying nervous and the other surrounding tissues. The histological examination failed to reveal adhesions, neomembrane formations, or any type of foreign body reactions to the polyurethane film. The implantation of the polysiloxane-carbonate film caused no reaction when it was applied epidurally. As a dural graft, the polysiloxane-carbonate copolymer induced the formation of a thin neomembrane of one to two layers of fibroblasts which formed a watertight seal of the dural defect. A similar thin neomembrane was found to encase this artificial membrane in the group of animals in which it was implanted subdurally. There was no foreign body reaction to the polysiloxane-carbonate film. The authors conclude that these materials hold promise as dural substitutes or in the prevention of spinal dural scarring, and should be evaluated clinically.

Intraoperative ventricular puncture during supraorbital craniotomy via an eyebrow incision

2006 ◽  
Vol 105 (3) ◽  
pp. 485-486 ◽  
Author(s):  
Tomas Menovsky ◽  
Joost de Vries ◽  
Johannes A. L. Wurzer ◽  
J. Andre Grotenhuis
Keyword(s):  
Mr Imaging ◽  
Frontal Lobe ◽  
Entry Point ◽  
Imaging Studies ◽  
Line Parallel ◽  
Frontal Horn ◽  
Imaginary Line ◽  
Eyebrow Incision ◽  
Ventricular Puncture ◽  
Supraorbital Craniotomy

✓ The authors determined the landmarks and coordinates for intraoperative ventricular puncture directly from the supraorbital craniotomy opening via an eyebrow incision. Fifty magnetic resonance (MR) imaging studies were obtained from patients with no pathological cerebral characteristics or ventricular distortion. The cerebral entry point of the ventriculostomy was located directly under the key bur hole (just behind the zygomatic process of the frontal bone) at the base of the frontal lobe because it represents a stable, reliable point that can be used as the bur hole during supraorbital craniotomy via an eyebrow incision. From this point, the coordinates for lateral ventricular puncture were determined using MR imaging studies and neuronavigational software. The cerebral entry point of the ventriculostomy was situated directly under the key bur hole at the base of the frontal lobe. The catheter was directed at a 45° angle to the midline and a 20° angle up from an imaginary line parallel to the orbitomeatal line. The catheter will usually be inserted into the ventricle at a point 5 cm deep to the cortex and may be inserted as deep as 6.5 cm. Using this technique, the frontal horn of the lateral ventricle can be easily tapped. The landmark required for this technique is readily available in all patients.

Delayed Presentation of Traumatic Cerebral and Dural Arteriovenous Fistulae After a BB Gun Accident in a Pediatric Patient: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. E1750-E1755 ◽  
Author(s):  
Adib A. Abla ◽  
Felipe C. Albuquerque ◽  
Nicholas Theodore ◽  
Robert F. Spetzler
Keyword(s):  
Computed Tomography ◽  
Frontal Lobe ◽  
Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Emergency Evacuation ◽  
Delayed Presentation ◽  
Skull Fractures ◽  
Low Velocity ◽  
Left Frontal Lobe ◽  
Neurologically Intact

Abstract BACKGROUND AND IMPORTANCE: To present a case of traumatic cortical and dural arteriovenous fistula (AVF) after a BB gun accident. CLINICAL PRESENTATION: The patient presented with a small left frontal subdural hematoma and small contusions in the left frontal lobe after he was shot with a BB. He had no skull fractures or significant midline shift. The patient, who was neurologically intact, was discharged after 3 days of observation and having undergone serial computed tomography imaging. Five days later, the patient developed lethargy and emesis. Computed tomography showed a 5 × 3 × 5 cm intraparenchymal hematoma in the left frontal lobe. Emergency evacuation of the hematoma revealed a cortical AVF, which was resected. Postoperative angiography showed a dural AVF of the left middle meningeal artery, draining into the superior ophthalmic vein and a dural vein. The dural AVF was embolized with n-butyl cyanoacrylate. The patient was discharged after 3 days with no deficits. CONCLUSION: The subdural hematoma and contusions were caused by a BB, which often are used in low-velocity and small caliber weapons. Not all BB guns are low velocity, and the consequences can be dramatic. The BB gun used here was pneumatic. The patient had no skull fractures. Several days of stable imaging and normal examinations suggested nothing sinister. His initial bleeds appeared disproportionate to the mechanism. The delayed presentation of the debilitating hematoma in this case stresses the need for vigilance on the part of practitioners and families when patients have a suspicious bleed.

Intracerebral pneumatocele presenting after air travel

2004 ◽  
Vol 101 (2) ◽  
pp. 340-342 ◽  
Author(s):  
Raman C. Mahabir ◽  
Artur Szymczak ◽  
Garnette R. Sutherland
Keyword(s):  
Frontal Lobe ◽  
Rare Complication ◽  
Air Travel ◽  
Ethmoid Sinus ◽  
Dural Defect ◽  
Imaging Evaluation ◽  
Content Type ◽  
Life Threatening ◽  
Persistent Headache ◽  
Frontal Lobe Syndrome

✓ In this report the authors discuss a patient who experienced symptoms of an acute right frontal, intraparenchymal pneumatocele while on an airplane descending to an international airport. This rare complication of an ethmoid sinus osteoma that eroded upward through the dura mater is described along with a literature review. A persistent headache and inappropriate behavior consistent with a frontal lobe syndrome brought the patient to clinical and imaging evaluation, which revealed a large right frontal lobe pneumatocele and an associated ethmoid sinus osteoma extending upward into the frontal lobe. Through a right frontal craniotomy, the air cavity was evacuated, the osteoma partially excised, and the dural defect closed using a vascularized pericranial flap. Postoperatively, the patient made an unremarkable recovery. For patients with air sinus osteomas extending into the cranial cavity, air travel or other barotrauma may result in a life-threatening tension pneumatocele.

scholarly journals Penetrating Facial Injury by a Tree Branch: a Case Report

2019 ◽  
Vol 11 (2) ◽  
pp. 85
Author(s):  
Marthinson A. Tombeng ◽  
Eko Prasetyo ◽  
Nico A. Lumintang ◽  
Maximillian Ch. Oley
Keyword(s):  
Foreign Body ◽  
Normal Function ◽  
Facial Trauma ◽  
Facial Injury ◽  
Penetrating Wound ◽  
Adjacent Structures ◽  
Minimal Trauma ◽  
The Face ◽  
The Right ◽  
Tree Branch

Abstrak: Cedera tembus wajah dapat berbahaya karena adanya struktur-struktur penting pada wajah yang membutuhkan penanganan dengan cepat dan tepat. Benda asing organik dapat menyebabkan risiko tinggi infeksi luka. Kami memresentasikan suatu kasus yang jarang ditemukan yaitu seorang laki-laki berusia 19 tahun dengan luka tembus wajah oleh patahan cabang pohon akibat kecelakaan sepeda motor. Panjang cabang pohon 25 cm dengan diameter sekitar 4 cm, menembus melalui sisi depan kanan wajah, tepat di samping hidung, dan menjorok keluar melalui sudut kanan mandibula. Evaluasi dan penatalaksanaan cedera tembus wajah dilakukan mengikuti protokol ATLS. Tujuan penatalaksanaan cedera tembus wajah ialah mengeluarkan benda asing dengan trauma minimal pada struktur berdekatan dan mempertahankan fungsi dan penampilan yang normal. Pasien ini menjalani operasi darurat untuk pengangkatan benda asing dan eksplorasi luka dengan anestesi umum. Evaluasi pasca operasi tidak mendapatkan adanya perdarahan maupun tanda-tanda infeksi. Defisit neurologik pada wajah kanan diterapi secara konservatif dengan terapi fisik dan pulih sepenuhnya satu tahun pasca kecelakaan.Kata kunci: luka tembus, trauma wajah, cabang pohonAbstract: Penetrating facial injury can be dangerous because of the presence of important structures in the face which requires immediate and proper management. Organic foreign bodies may cause a high risk of wound infection. We present a case of a 19-year-old male with an unusual penetrating facial injury by a broken tree branch due to a motorcycle accident. The length of the tree branch was 25 cm with a diameter of approximately 4 cm, penetrating through the right anterior side of his face, just lateral to the nose, and protruding through the right angle of the mandible. The evaluation and management of the penetrating facial injury were performed in accordance with the ATLS protocol. The aim of the penetrating facial injuries management is to remove foreign body with minimal trauma to adjacent structures and to maintain the normal function and appearance. The patient underwent emergency surgery for removal of the foreign body and wound exploration under general anesthesia. In postoperative evaluation, there was not any bleeding or signs of infection. The neurological deficit in the right face was managed conservatively with physical therapy and was fully recovered in 1 year after the accident.Keywords: penetrating wound, facial trauma, tree branch

scholarly journals Unusual intrathoracic foreign body: tree branch

2016 ◽  
Vol 49 (5) ◽  
pp. 345-346
Author(s):  
Diogo Goulart Corrêa ◽  
Tiago Medina Salata ◽  
Luiz Sérgio Carvalho Teixeira ◽  
Rafael Silveira Borges ◽  
Edson Marchiori
Keyword(s):  
Foreign Body ◽  
Tree Branch

Abstract 191: Selective Frontal Lobe Metabolic Dysfunction After Sub-arachnoid Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Halinder S Mangat ◽  
Jana Ivanidze ◽  
Xiangling Mao ◽  
Dikoma Shungu ◽  
Malik Fakhar ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Frontal Lobe ◽  
Ct Perfusion ◽  
Neurological Deficits ◽  
High Morbidity ◽  
Metabolic Dysfunction ◽  
Fisher Score ◽  
Csf Lactate ◽  
Occipital Lobes ◽  
Neurologically Intact

Aneurysmal SAH results in high morbidity. Patients who make a good neurological recovery report significant neuropsychological impairment such as loss of motivation, interests, and concentration, all of which are commonly associated with frontal lobe dysfunction. We hypothesize that subclinical frontal lobe injury occurs in neurologically intact SAH patients and may be identified by measuring brain energy metabolism using regional N-acetyl aspartate (NAA) as an imaging marker of neuronal integrity and mitochondrial function, and CSF lactate, as a marker of anaerobic metabolism. We utilized MR Spectroscopy (MRS) to measure regional NAA in SAH patients who had suffered neither cerebral infarction nor neurological deficits. Only patients who underwent endovascular aneurysm coiling were included. Measurements were made in frontal, temporal, occipital lobes, lateral ventricles, and averaged in each hemisphere from 3 slices. Matching ROIs were placed on the most proximate CT perfusion maps to measure corresponding rCBF. MR spectra were compared to controls from our data library (7 subjects) and to rCBF. Average age was 58 years, Hunt Hess score was 2.43±1.09, modified Fisher score was 2.79±1.05. 3 patients had DCI and none had cerebral infarction. Median GCS at discharge was 15. MRS was done at 9.93±7.73 days from admission. 1 patient had no MRS data, 3 patients had no CT perfusion. SAH patients demonstrated significantly reduced NAA/RMS in frontal lobes (16.18±4.96 vs. 20.93±5.56, p=0.042) but not in temporal (16.49±4.37 vs. 19.37±4.38, p=0.09) or occipital lobes (20.62±4.50 vs. 21.05±4.23, p=0.41). CSF lactate was significantly higher in SAH patients (7.74±2.27 vs. 4.02±0.76, p=0.001). NAA/RMS did not correlate with CBF in pooled data (R 2 =0.02, p=0.40) or in frontal lobe rCBF (R 2 =0.001, p=0.92); nor with CSF lactate (R 2 =0.02, p=0.53). Total frontal lobe NAA is selectively reduced and CSF lactate is elevated in neurologically intact survivors after SAH. This preliminary data is suggestive of energy depletion and subclinical brain injury, which appears to be independent of cerebral blood flow. In addition to validating this pilot data, we will study the association with cognitive impairment in these patients.

scholarly journals Endovascular coil embolization of unruptured posterior communicating artery aneurysm

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Mandy Binning ◽  
Zakaria Hakma ◽  
Erol Veznedaroglu
Keyword(s):  
Coil Embolization ◽  
Artery Aneurysm ◽  
Care Physician ◽  
Posterior Communicating Artery ◽  
Ct Angiogram ◽  
Endovascular Coil Embolization ◽  
Posterior Communicating Artery Aneurysm ◽  
Neurologically Intact ◽  
Aneurysm Coiling ◽  
New Onset

The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm. Digitally subtracted cerebral angiography confirmed these measurements and showed that the aneurysm was amenable to endovascular coil embolization. The patient underwent aneurysm coiling without complication and was discharged to home on postoperative Day 1.The video can be found here: http://youtu.be/MjOc3Zpv2K8.

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