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1/89. The importance of CT scans in planning the removal of orbital-frontal lobe foreign bodies.

    PURPOSE: To describe the management of foreign bodies in the orbit and frontal lobe. methods: Reports of two cases. RESULTS: Both patients underwent successful removal of an orbital-cerebral foreign body by anterior orbitotomy. CONCLUSION: Computed tomography was useful to confirm preoperatively that the foreign body was not adjacent to cerebral blood vessels and to monitor postoperatively for cerebral hemorrhage. A team approach is necessary in the management of orbital-frontal lobe foreign bodies. ( info)

2/89. glioblastoma multiforme at the site of metal splinter injury: a coincidence? Case report.

    The authors report the case of a man who had suffered a penetrating metal splinter injury to the left frontal lobe at 18 years of age. Thirty-seven years later the patient developed a left-sided frontal tumor at the precise site of the meningocerebral scar and posttraumatic defect. Histological examination confirmed a glioblastoma multiforme adjacent to the dural scar and metal splinters. In addition, a chronic abscess from which propionibacterium acnes was isolated was found within the glioma tissue. The temporal and local association of metal splinter injury with chronic abscess, scar formation, and malignant glioma is highly suggestive of a causal relationship between trauma and the development of a malignant brain tumor. ( info)

3/89. Penetrating craniocerebral injury from an underwater fishing harpoon.

    Weapon injuries other than gunshot wounds or low-velocity stab wounds to the head are extremely rare. We report the case of a 6-year-old girl who sustained a penetrating craniocerebral injury after being accidentally shot with an underwater fishing harpoon. This mechanism of injury seems to share characteristics of both high- and low-velocity projectiles. We discuss the management of this unusual injury in a child, remarking that foreign body removal in these cases must be carried out following the original direction of the projectile trajectory. We review the current literature on craniocerebral injuries caused by similar objects, especially those occurring in children. ( info)

4/89. Traumatic intracranial aneurysms following penetrating stab wounds to the head: two unusual cases and review of the literature.

    Two patients with rare complications of traumatic intracranial aneurysms following penetrating cranial stab wounds are described. One patient had a good outcome despite a secondary rupture of a traumatic proximal middle cerebral artery aneurysm, while the second patient had a traumatic basilar bifurcation artery aneurysm. To our knowledge neither the survival from a secondary rupture of a traumatic intracranial aneurysm, nor the development of a basilar bifurcation aneurysm secondary to a transcranial stab wound has been described previously. Furthermore, this is the first report of the technique of deep hypothermic cardiac arrest utilized to treat a traumatic false aneurysm. Traumatic intracranial aneurysms are a rare clinical entity, most often diagnosed after rupture and often resulting in fatal haemorrhage. A high index of suspicion needs to be maintained when managing patients with transcranial stab wounds. Early surgical intervention improves outcome by preventing initial aneurysmal rupture or rebleeding. ( info)

5/89. Pituitary insufficiency after penetrating injury to the sella turcica.

    We report a 28-year-old male patient with a pituitary insufficiency after a simple fracture of the sella turcica. He was injured by a long nail that punctured the lower jaw. No fracture other than that of the sella turcica was detected. An endocrinological examination revealed both anterior and pituitary dysfunction and diabetes insipidus that continued for about two months. ( info)

6/89. Orbitocranial injury caused by wood.

    A rare case of a patient with orbitocranial injury by a wooden foreign body is reported. Penetrating periorbital wound by a wooden stick with entry site at the right upper eyelid was related to the invasion into the temporal lobe. Fortunately, the anterior and posterior segments of eye were unharmed, but right ocular motility was markedly restricted mechanically in all directions. Forced duction test was strong positive, especially the dextroversion of the right eye. Computed tomography scan showed a well-delineated low density from the orbital wall into the temporal lobe. The wooden foreign body was subsequently removed from the orbit and the temporal lobe, through the neurosurgical frontotemporal approach. After the wooden foreign body was removed, the ocular movement of the right eye fully recovered without any intracranial or ocular complications. ( info)

7/89. Surgical treatment of penetrating orbito-cranial injuries. Case report.

    Penetrating orbital injuries are not frequent but neither are they rare. The various diagnostic and therapeutic problems are related to the nature of the penetrating object, its velocity, shape and size as well as the possibility that it may be partially or wholly retained within the orbit. The authors present another case with unusual characteristics and discuss the strategies available for the best possible treatment of this traumatic pathology in the light of the published data. The patient in this case was a young man involved in a road accident who presented orbito-cerebral penetration caused by a metal rod with a protective plastic cap. Following the accident, the plastic cap (2.5x2 cm) was partially retained in the orbit. At initial clinical examination, damage appeared to be exclusively ophthalmological. Subsequent CT scan demonstrated the degree of intracerebral involvement. The damaged cerebral tissue was removed together with bone fragments via a bifrontal craniotomy, the foreign body was extracted and the dura repaired. Postoperative recovery was normal and there were no neuro-ophthalmological deficits at long-term clinical assessment. Orbito-cranial penetration, which is generally associated with violent injuries caused by high-velocity missiles, may not be suspected in traumas produced by low-velocity objects. Diagnostic orientation largely depends on precise knowledge of the traumatic event and the object responsible. When penetration is suspected and/or the object responsible is inadequately identified, a CT scan is indicated. The type of procedure to adopt for extraction, depends on the size and nature of the retained object. Although the possibility of non-surgical extraction has been described, surgical removal is the safest form of treatment in cases with extensive laceration and brain contusion. ( info)

8/89. Screwdriver assaults and intracranial injuries.

    Four patients with intracranial penetrating injuries from screwdrivers are presented. Two cases were fatal; the others were left with functional deficits. In two of the patients a penetrating injury was not suspected initially because the history was limited and the significance of the small entry wounds were not appreciated. Unless these wounds are carefully examined a penetrating injury is easily overlooked. ( info)

9/89. Transnasal penetrating brain injury with a ball-pen.

    We report a case of a 44-year-old man with 1 day's history of epistaxis. He was an in-patient in a psychiatric ward with a history of depression. He had CSF rhinorrhoea, was confused and had no focal neurological deficits. A full length pencil was removed from his left nostril in the emergency department. CT of the brain revealed a tract, but also suggested another foreign body in the inter-hemispheric space. He had a para-sagittal craniotomy and a 14 cm ball-point pen was found lying between the two cerebral hemispheres. This was removed and the patient made an uneventful recovery. This is the first report of an attempted suicide by transnasal insertion of a ballpoint pen intracranially. ( info)

10/89. brain abscess decades after a penetrating shrapnel injury.

    We describe a patient who developed a brain abscess 52 years after sustaining a penetrating craniocerebral shrapnel injury. For 10 years he had suffered from diabetes mellitus, a disorder known to predispose to infections from a diminished body defence. The treatment and aetiology of this rare occurrence is discussed. ( info)
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