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Updated: Feb 22, 2026
Three-Dimensional Reconstruction of Orbital Fractures
Published on: May 16, 2025
Penetrating orbital trauma leading to trans-orbital brain herniation
Siddharth Vankipuram1, Chittij Srivastava2, B K Ojha2
1Department of Neurosurgery, Shatabdi Hospital Phase 2, King George Medical University, Lucknow, Uttar Pradesh, 226003, India. vanki.siddharth@gmail.com.
Introduction:
Development of a posttraumatic herniation of brain parenchyma through the orbit is a rare complication of orbital roof fracture. Mostly, the injury is due to a direct impact to the frontal region resulting in orbital roof fracture with dural defect and herniation of cerebrospinal fluid or brain parenchyma. These patients present with acute or gradually progressive proptosis with impending risk of loss of vision and mandate surgical decompression of optic nerve with watertight closure of the dural defect. Bony reconstruction may be required to achieve normal contour of the orbit.
Materials And Methods:
We encountered an interesting pediatric patient who presented to us with altered sensorium and progressive proptosis 3 days after a penetrating trauma to his left orbit by falling on the handle of a bicycle. The plain computerized tomography of the head (NCCT) showed a left orbital roof defect with herniation of brain matter into the orbit displacing the globe inferolaterally. A craniotomy was performed and watertight closure of the dural rent was achieved with use of autologous bone to cover the defect.
Conclusions:
The child improved gradually, and at 6 months follow-up, he had good cosmetic outcome with improvement of vision.
