Santander Xavier A, Revuelta Juan Manuel, Cotúa Carlos, Arellano Rodriguez Beatriz, de Leyva Moreno Patricia, Saab Mazzei Anwar
Department of Neurosurgery, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain.
Department of Neurosurgery, Clínico San Carlos Hospital, Madrid, Spain.
World Neurosurg. 2019 Jun;126:530-532. doi: 10.1016/j.wneu.2019.02.154. Epub 2019 Mar 20.
We present the case of a 51-year-old male with an occult transorbital intracranial injury after a car accident. The identified foreign object was a windshield wiper handle. To our knowledge, this is the first case reported.
Multidisciplinary treatment with maxillofacial and otorhinolaryngology departments was planned. A bifrontal craniotomy with removal of the foreign object and posterior orbital reconstruction were performed. A review of the literature was done, in order to highlight certain general principles in decision making despite the variability in case presentation.
Occult TII is a rare subtype of penetrating brain injury. Diagnosis requires high suspicion as it can be missed during physical examination. Computed tomography (CT) scan, CT angiogram, and magnetic resonance imaging should be performed in order to design the optimal treatment for each patient. Magnetic resonance imaging should be avoided when metallic density on CT is observed. The use of a broad-spectrum antibiotic regimen is critical.
我们报告一例51岁男性在车祸后发生隐匿性经眶颅内损伤的病例。发现的异物是一个挡风玻璃刮水器手柄。据我们所知，这是首例报道的此类病例。
计划由颌面外科和耳鼻咽喉科进行多学科治疗。实施了双额开颅术以取出异物并进行眶后重建。进行了文献回顾，以突出尽管病例表现存在差异但决策中的某些一般原则。
隐匿性经眶颅内损伤是穿透性脑损伤的一种罕见亚型。诊断需要高度怀疑，因为在体格检查时可能会漏诊。应进行计算机断层扫描（CT）、CT血管造影和磁共振成像，以便为每位患者设计最佳治疗方案。当在CT上观察到金属密度时，应避免使用磁共振成像。使用广谱抗生素方案至关重要。
