Xu Feifan, Li Jingsheng, Sun Shengjun, Guo Eran, Hao Shuyu, Hou Zonggang, Leung Gilberto Ka Kit, Liu Baiyun
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
Brain Inj. 2013;27(7-8):951-6. doi: 10.3109/02699052.2013.775502. Epub 2013 Jun 19.
Penetrating orbital injuries constitute a significant threat to ocular and cerebral structures. The incidence of central nervous system damage from orbital injury is related to the orbital anatomy and the characteristics of the penetrating object. Penetrating orbital injuries involving the brain stem are extremely rare.
To present an uncommon case of penetrating orbital injury and to discuss surgical management.
A patient suffered from a penetrating injury by a Bakelite comb which extended from his left orbit through the cavernous sinus to the pons. Complete occlusion of the left cavernous segment of the internal carotid artery was detected and a frontotemporal craniotomy with lateral superior orbitotomy was performed to remove the object. A delayed asymptomatic carotid-cavernous fistula was identified 1 year later.
Surgical treatment remains the mainstay of intervention for penetrating orbitocranial injuries. The rationale of surgical removal of a foreign body should focus on safe exposure and removal of the object at the earliest without inflicting further injuries. Close follow-up for a delayed carotid-cavernous fistula is necessary.
穿透性眼眶损伤对眼部和脑部结构构成重大威胁。眼眶损伤导致中枢神经系统损伤的发生率与眼眶解剖结构及穿透物体的特性有关。累及脑干的穿透性眼眶损伤极为罕见。
介绍一例罕见的穿透性眼眶损伤病例并探讨手术治疗方法。
一名患者被酚醛树脂梳子穿透致伤，伤口从左眼眶经海绵窦延伸至脑桥。检测发现左侧颈内动脉海绵窦段完全闭塞，遂行额颞开颅术联合眶上外侧切开术取出异物。1年后发现迟发性无症状性颈内动脉海绵窦瘘。
手术治疗仍是穿透性眶颅损伤的主要干预手段。手术取出异物的原则应聚焦于尽早安全暴露并取出异物，同时避免造成进一步损伤。对于迟发性颈内动脉海绵窦瘘，密切随访很有必要。
