Novel endoscopic management of penetrating intracranial trauma

We report a unique case of minimally invasive endoscopic removal of a penetrating orbitocranial foreign body (POCFB), and present a review of the literature. A 12-year-old boy was impaled in the orbit with a gate latch. Neurosurgical consultation ascertained that removal via bifrontal craniotomy would necessitate extensive brain retraction and result in permanent anosmia. Attempting nasal endoscopic removal was deemed prudent, given this morbidity and a lack of brain parenchymal violation. The patient recovered without a cerebrospinal fluid leak or other neurologic sequelae. To date, craniotomy is the only reported management of POCFBs in the literature. We herein report the first nasal endoscopic removal of a POCFB.