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Delayed presentation of transorbital intracranial pen
G A Davis1, A D Holmes, G L Klug
1Departments of Neurosurgery and Plastic/Craniofacial Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.
Summary
A 13-year-old boy had a plastic pen lodged in his brain for three years after a stab wound. Doctors successfully removed the foreign body, preserving vision in his only seeing eye.
Area of Science:
- Ophthalmology
- Neurosurgery
- Radiology
Background:
- A 13-year-old boy presented with a chronic orbital stab wound.
- The initial injury involved a plastic pen penetrating the left orbit, traversing the nasal cavity, right orbit, and right optic nerve, lodging in the right temporal lobe.
Observation:
- The retained foreign body remained in situ for three years.
- The entry wound was noted in the left lower eyelid, with discharge.
- Computed tomography (CT) imaging failed to detect the foreign body, but magnetic resonance imaging (MRI) successfully identified it.
Findings:
- A complex craniofacial surgical approach was performed by combined neurosurgery and plastic surgery teams.
- Complete removal of the retained plastic pen was achieved.
- Vision in the patient's only seeing eye was successfully preserved.
Implications:
- Highlights the diagnostic challenges of deeply retained orbital foreign bodies.
- Emphasizes the critical role of advanced imaging modalities like MRI in detecting non-radiopaque foreign materials.
- Demonstrates the successful management of a rare and complex craniofacial injury with preservation of vital neurological function and vision.