Post-traumatic internal carotid aneurysms caused by needlefish: lessons from one success story

Penetrating injuries caused by marine animals are rare, particularly those involving the needlefish (Belonidae), which can cause significant orbital and intracranial trauma due to its elongated, serrated jaws. This report details a unique case of a successful resolution of this type of injury in Mexico.

A 10-year-old girl sustained a penetrating injury to her right eye while fishing in the Usumacinta River when a needlefish's jaws became embedded in her eye socket. Imaging revealed a foreign body penetrating the cavernous sinus and internal carotid artery (ICA) segment C4. Following a pterional craniotomy and successful removal of two osteocartilaginous fragments, postoperative angiography identified two ICA pseudoaneurysms. The patient was treated endovascularly and discharged without additional neurological deficits.

Clinicians must consider intracranial penetration and vascular complications, such as pseudoaneurysms, in patients presenting with periorbital edema or oculomotor palsy following aquatic activities.