Deep penetrating orbitocerebral steel spring injury with minimal sequelae: a case report

The authors report a penetrating orbitocerebral steel mattress spring injury without permanent ophthalmic or neurologic sequelae. A 44-year-old female mattress factory worker sustained an injury to her right orbit by a high-velocity projectile foreign body. Imaging revealed a metallic spring in the right orbit traversing the optic nerve and superior orbital fissure and lodging in the temporal lobe of the brain. Cerebral angiography demonstrated the steel coil around, but not damaging, the middle cerebral artery and other vessels. With a combined craniotomy and frontal orbitotomy, the spring was removed by meticulous counterclockwise rotation. Postoperatively, the patient had mild left-sided weakness that resolved after several weeks. Ocular examination was normal, including full extraocular movements and a visual acuity of 20/20 in each eye. The authors theorize that the spiral shape and on-axis rotational movement allowed the projectile to follow a path of least resistance penetrating deeply and coiling around, but not injuring, vital structures. Careful counterclockwise rotation under direct intracranial and intraorbital visualization was effective in removing the spring.