Mzimbiri Juma M, Li Jian, Bajawi Mdaish A, Lan Song, Chen Fenghua, Liu Jinfang
Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Neurosurgery, Muhimbili Orthopedic and Neurosurgical Institute, Dar es salaam, Tanzania.
Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
World Neurosurg. 2016 Mar;87:26-34. doi: 10.1016/j.wneu.2015.12.063. Epub 2015 Dec 24.
Orbitocranial penetrating injuries (OPI) are an unfamiliar subset of head injury and are particularly rare in clinical practice. They are usually the result of falls or motor vehicle collisions and occur more commonly in children, who are prone to trauma while playing games improperly.
We present a retrospective review of 5 cases of OPI treated in the Neurotrauma Department at Xiangya Hospital of Central South University in the last 5 years. Also, we performed comprehensive literature searches using Web of Science and the terms "orbitocranial injury," "penetrating ocular trauma," "penetrating orbital trauma," and "transorbital chopstick penetrating injury" to search for presentation, mechanism of injury, and management of transorbital penetrating injury.
In 2 patients, there was right internal carotid artery occlusion while in other 2 patients, the penetrating objects reached the brainstem through the cavernous sinus, resulting in orbital apex syndrome. All patients underwent a thorough physical examination followed by diagnostic imaging. The cases were successfully managed surgically by removing the foreign bodies through their trajectories.
Computed tomography, magnetic resonance imaging, and computed tomography angiography are key imaging modalities that are frequently used to determine the course of the foreign object and the extent of brain tissue injury as well as to rule out vascular injury in these types of cases. Early surgical exploration by a multidisciplinary team approach is essential to attain good recovery and a favorable outcome.
眶颅穿透伤（OPI）是一种临床少见的头部损伤类型，在临床实践中尤为罕见。它们通常是跌倒或机动车碰撞的结果，在儿童中更为常见，儿童在不当玩耍时容易受到创伤。
我们对中南大学湘雅医院神经创伤科过去5年治疗的5例眶颅穿透伤病例进行了回顾性研究。此外，我们使用科学网以及“眶颅损伤”“穿透性眼外伤”“穿透性眶外伤”和“经眶筷子穿透伤”等术语进行了全面的文献检索，以查找经眶穿透伤的表现、损伤机制和治疗方法。
2例患者出现右侧颈内动脉闭塞，另外2例患者中，穿透物体经海绵窦到达脑干，导致眶尖综合征。所有患者均接受了全面的体格检查，随后进行了诊断性影像学检查。通过沿异物轨迹取出异物，这些病例均成功接受了手术治疗。
计算机断层扫描、磁共振成像和计算机断层血管造影是常用的关键影像学检查方法，可用于确定异物的行径、脑组织损伤的程度以及排除此类病例中的血管损伤。多学科团队的早期手术探查对于实现良好的恢复和理想的预后至关重要。
