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Angiografía cerebral que evidencia relación de cuerpo extraño con carótida y seno cavernoso (2.B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esteban Torche Velez, Pablo Rojas Vilarroel, Franco Vera Figueroa, Sebastián Vigueras Alvarez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Esteban" "apellidos" => "Torche Velez" ] 1 => array:2 [ "nombre" => "Pablo" "apellidos" => "Rojas Vilarroel" ] 2 => array:2 [ "nombre" => "Franco" "apellidos" => "Vera Figueroa" ] 3 => array:2 [ "nombre" => "Sebastián" "apellidos" => "Vigueras Alvarez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529849622000120" "doi" => "10.1016/j.neucie.2022.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849622000120?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147321000956?idApp=UINPBA00004B" "url" => "/11301473/0000003300000006/v1_202211020527/S1130147321000956/v1_202211020527/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2529849622000144" "issn" => "25298496" "doi" => "10.1016/j.neucie.2022.02.005" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "524" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Neurocirugia. 2022;33:383-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Primary intracranial melanoma, amelanotic variant: Case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "383" "paginaFinal" => "388" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Variante amelanótica en melanoma cerebral primario: a propósito de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1178 "Ancho" => 1500 "Tamanyo" => 209218 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Preoperative imaging studies. A: brain CT with contrast; B: axial MRI (T1); C: axial MRI (T2); D: T1-weighted contrast-enhanced MRI, axial slice and coronal and sagittal reconstructions.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A mass can be seen in the right frontal region, measuring 62 mm in its major axis. It is causing a notable mass effect and surrounding oedema, with midline shift of 15 mm. It is hypointense on T1 and isointense on T2 (amelanotic pattern). It enhances with contrast in both CT and MRI. Thick nutrient vessels can be seen on MRI + C.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Julio Alberto Andrés Sanz, Juan Antonio Ruiz Ginés, Hristo Iliev, Jesús Aguas Valiente" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Julio Alberto" "apellidos" => "Andrés Sanz" ] 1 => array:2 [ "nombre" => "Juan Antonio" "apellidos" => "Ruiz Ginés" ] 2 => array:2 [ "nombre" => "Hristo" "apellidos" => "Iliev" ] 3 => array:2 [ "nombre" => "Jesús" "apellidos" => "Aguas Valiente" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1130147321001093" "doi" => "10.1016/j.neucir.2021.08.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147321001093?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849622000144?idApp=UINPBA00004B" "url" => "/25298496/0000003300000006/v3_202212060641/S2529849622000144/v3_202212060641/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529849622000636" "issn" => "25298496" "doi" => "10.1016/j.neucie.2021.07.004" "estado" => "S300" "fechaPublicacion" => "2022-11-01" "aid" => "519" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Neurocirugia. 2022;33:371-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Recurrent meningeal malignant tumor: Assessment of differences in the solitary fibrous tumor/hemangiopericytoma spectrum through a case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "371" "paginaFinal" => "376" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumor maligno recurrente de origen meníngeo: evaluación de las diferencias de la entidad tumor fibroso solitario/hemangiopericitoma mediante un caso clínico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 505 "Ancho" => 1255 "Tamanyo" => 173810 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(a) 1× magnification photomicrograph, stained with hematoxylin and eosin. A well-defined, homogeneously growing nodular tumor was demonstrated. There were detailed empty spaces that could refer to vascular structures. Scale bar: 2<span class="elsevierStyleHsp" style=""></span>mm. (b) 10× magnification photomicrograph, stained with hematoxylin and eosin. It was assessed a fascicular cell proliferation and a vascular pattern among them, consisted of elongated and thin-walled branching hemangiopericytoma-like (staghorn) vessels. 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Gradual extraction of pencil from the base of the skull (3.B.I, 3.B.II and 3.B.III). Black arrow indicates CSF fistula through defect in the sellar floor caused by foreign body (3.C.I, 3.C.II and 3.C.III). Closure of dural defect with fat patch, nasoseptal flap and DuraSeal (3.D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Penetrating intracranial injuries are a major cause of death and disability, primarily due to neurovascular injury and central nervous system infection (meningitis). The incidence is 0.4% of all brain injuries (at all ages).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Of all penetrating intracranial injuries, 24% in adults and 45% in children are orbitocranial. They are more common in males than females.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The causes of injuries are multiple and include physical attacks, high-energy accidents and self-injury (psychiatric patients), etc. In the paediatric population, orbitocranial injuries are more common in the context of domestic, social or school activities.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Multidisciplinary management is very important, including specialists in ophthalmology, paediatrics, otorhinolaryngology, maxillofacial surgery, neuroradiology, neurosurgery, etc. Treatment is focused not only on removal of the foreign body, but also on preventing infection and reducing damage to surrounding structures.</p><p id="par0020" class="elsevierStylePara elsevierViewall">When the penetrating injury involves the anterior part of the cavernous sinus, we should suspect a carotid artery injury (dissection, pseudoaneurysm or traumatic laceration). CT angiography, magnetic resonance angiography, and standard angiography examinations are helpful in confirming the diagnosis and guiding treatment.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">If a carotid lesion is suspected, it is recommended to plan vascular (carotid) control using an open or endovascular technique (intracarotid balloon) when removing the foreign body.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0030" class="elsevierStylePara elsevierViewall">We present the case of a six-year-old female patient, who was brought into the Emergency Department by school staff, because she had suffered a fall from a standing height, resulting in a penetrating wound in her left orbit, with a foreign body (pencil) visibly embedded through the orbit. When taken into the cubicle to be seen, the patient scored 15 on the Glasgow Coma Scale and had a foreign body penetrating her left orbit.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The physical-neurological examination revealed an awake, orientated, cooperative, attentive patient, capable of following simple and complex orders, without neurological compromise of long pathways or cranial nerves. Her vital signs were normal (blood pressure, heart rate, temperature and pulse oximetry). Ocular motility and visual acuity assessment were normal.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Computed tomography angiography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) of the brain was performed in bone window, angiotomography and 3D bone reconstruction mode. A foreign body was identified through the left orbit, crossing the midline through the ethmoid cells and the sphenoid sinus, penetrating the sella turcica and stopping at the level of the medial wall of the right cavernous sinus.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">General and hormonal laboratory test results were normal.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the close relationship with the right cavernous sinus, cerebral angiography was requested. The patient was transferred to the neurovascular ward (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.A), where cerebral angiography was performed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.B), confirming deformity and displacement of the carotid artery, without injury to the arterial wall. A balloon occlusion test was positive for adequate competence of communicating vessels.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical case was evaluated early by a multidisciplinary team and it was decided to remove the foreign body by endoscopic technique via the trans-sphenoidal endonasal route, on the neurovascular ward under endovascular control, with an intracarotid balloon when removing the foreign body.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In the event of rupture and bleeding of the carotid artery, the following were planned: 1) carotid occlusion with a balloon; 2) carotid trapping; and 3) creation of rescue cerebral bypass.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Endonasal endoscopic access was adequate for visualisation and extraction of the foreign body, which had an obvious course from left to right, through the sella turcica towards the right cavernous sinus (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.A). The foreign body was cut at the level of the ethmoid bone, achieving extraction of the external portion by traction, freeing the left orbit.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Before extracting the proximal portion of the foreign body which was in contact with the carotid artery, endovascular control was performed with a balloon (at the level of the cervical carotid artery) and then, by means of gentle and continuous traction, the foreign body was extracted from the base of the skull (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.B.I, 3.B.II and 3.B.III).</p><p id="par0075" class="elsevierStylePara elsevierViewall">When extracting the portion of the pencil that had impacted the cavernous sinus, a CSF fistula was observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.C.I and 3.C.II). Profuse lavage with normal saline was performed and small foreign body fragments were removed from the surgical bed. The fistula was closed with fat inside the sella turcica + lift of the nasoseptal flap (Hadad-Bassagasteguy flap) + application of "DuraSeal" (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.D).</p><p id="par0080" class="elsevierStylePara elsevierViewall">The patient made good progress with no early or late postoperative complications, and completed a 14-day course of antibiotic treatment. She was discharged after 15 days in hospital, with no neurological deficits, no CSF leak, and no obvious ophthalmological complications.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Now, three years after the traumatic event, the patient remains free of complications and has fully resumed her usual school and extracurricular activities.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0090" class="elsevierStylePara elsevierViewall">There is a high risk of penetrating orbitocranial injuries in the paediatric population due to the characteristics of their cranial anatomy.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The most common entry site is the roof of the orbit because of the thinness of its wall.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The second most common site of entry is the squamous portion of the temporal bone, where it may compromise the temporal and frontal lobes on entry or during its intracranial trajectory.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Other less common trajectories include the medial wall of the cavernous sinus, as in the case we present here, or the superior orbital fissure, towards the temporal lobe or brain stem.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">There is currently no international consensus on the management of this type of injury, especially in paediatric patients.</p><p id="par0115" class="elsevierStylePara elsevierViewall">To determine the prognosis, we can focus on the Glasgow Coma Scale, pupil assessment and tomography findings on admission.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Glasgow Coma Scale on admission is an important prognostic indicator, particularly if the score is >13.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">9</span></a> Other important prognostic factors are pupil size, symmetry and reactivity to light. The tomography findings are important in the prognosis, particularly if intracranial haematomas are identified, as this would make the outcome less hopeful.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">9</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">There are primary and secondary injuries associated with this type of trauma:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0130" class="elsevierStylePara elsevierViewall">Primary injuries include bone compromise associated with parenchymal contusions, haematomas, CSF leak and vascular damage.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0135" class="elsevierStylePara elsevierViewall">Secondary injuries (or complications) are divided into early (0–7 days) and late (>7 days).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">∘</span><p id="par0140" class="elsevierStylePara elsevierViewall">Early complications include ischaemia, seizures, and central nervous system infections caused by the foreign body or a CSF leak.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">∘</span><p id="par0145" class="elsevierStylePara elsevierViewall">Late complications are mainly due to the presence of vascular laceration and/or foreign body debris. These lesions include aneurysms, pseudoaneurysms, arteriovenous fistulas, central nervous system infections, seizures and migration of foreign bodies.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">9</span></a></p></li></ul></p><p id="par0150" class="elsevierStylePara elsevierViewall">The most common late vascular complication is traumatic intracranial aneurysm. This can be a true aneurysm as a result of damage to the arterial wall or, more commonly, a pseudoaneurysm (due to cavitation formed by haematoma around the injured vessel).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Vascular injury should be suspected in all trauma involving the base of the skull or fractures with multiple fragments to the temporal bone, clivus or sphenoid bone, particularly near the cavernous sinus.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In cases in which we suspect vascular injury, it is advisable not to remove the foreign body too soon, wait 6−12 h, and obtain assistance from an endovascular team, in order to reduce bleeding in case the carotid wall or other vessels are damaged.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Digital subtraction angiography is the “gold standard” for examining vascular lesions, and it can also help optimise vascular control through balloon occlusion. It should also be taken into account that, in certain cases, the endovascular route will be the safest way to treat some injuries.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Infectious complications can occur in up to 64% of cases,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a> with <span class="elsevierStyleItalic">Staphylococcus aureus</span> and gram-negative bacteria being the germs most commonly documented.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The following strategy should be used to reduce the risk of infection<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a>:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">1</span><p id="par0180" class="elsevierStylePara elsevierViewall">Empirical prophylactic antibiotic for at least 7–14 days.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2</span><p id="par0185" class="elsevierStylePara elsevierViewall">Early surgical washout (within the first 6–12 h).</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3</span><p id="par0190" class="elsevierStylePara elsevierViewall">Immunisation against tetanus (depending on the patient's previous immunisation status).</p></li></ul></p><p id="par0195" class="elsevierStylePara elsevierViewall">The use of anticonvulsant therapy is suggested in patients with non-convulsive penetrating brain injury for a period of up to seven days, to prevent early seizures.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">It is recommended to remove the foreign body on the ward under general anaesthesia, generally under direct vision, by craniotomy alone or with endoscopic support.</p><p id="par0205" class="elsevierStylePara elsevierViewall">We have presented a useful different way in a paediatric patient, using the endonasal endoscopic route (trans-sphenoidal) with endovascular support, with very good results.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0210" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1</span><p id="par0215" class="elsevierStylePara elsevierViewall">Transorbital penetrating intracranial injuries in the paediatric population are rare and even more so when these injuries compromise the cavernous sinus.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2</span><p id="par0220" class="elsevierStylePara elsevierViewall">Such cases should be handled by a multidisciplinary team.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3</span><p id="par0225" class="elsevierStylePara elsevierViewall">Cerebral angiography should be performed to adequately visualise the cerebral vascular anatomy and the possible compromise of said structures.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4</span><p id="par0230" class="elsevierStylePara elsevierViewall">Endonasal endoscopic access is an alternative for the visualisation and extraction of such foreign bodies, in addition to allowing the repair of CSF leaks.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5</span><p id="par0235" class="elsevierStylePara elsevierViewall">Endovascular support means we have vascular control through an intracarotid balloon, increasing the safety of the procedure.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">6</span><p id="par0240" class="elsevierStylePara elsevierViewall">In cases with risk of carotid injury and bleeding during surgery, the steps to follow should be planned in advance, considering carotid occlusion and possible emergency cerebral revascularisation surgery.</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Funding</span><p id="par0250" class="elsevierStylePara elsevierViewall">The research was carried out without any funding.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1814933" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1584577" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1814932" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1584576" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-01-26" "fechaAceptado" => "2021-08-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1584577" "palabras" => array:6 [ 0 => "Penetrating orbitocranial trauma" 1 => "Cavernous sinus lesion" 2 => "Cavernous carotid injury" 3 => "Foreign body resection of the cranial base" 4 => "Neuroendoscopy" 5 => "Endoscopic resection of intracranial foreign body" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1584576" "palabras" => array:6 [ 0 => "Trauma penetrante orbitocranial" 1 => "Lesión de seno cavernoso" 2 => "Lesión de carótida cavernosa" 3 => "Resección cuerpo extraño base de cráneo" 4 => "Neuroendoscopia" 5 => "Resección endoscópica cuerpo extraño intracraneal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Transorbitary intracranial penetrating traumatic injuries are uncommon in the paediatric population, and may occur in the context of domestic, sporting or school accidents. They can extend to skull base and compromise vascular structures such as cavernous sinus and internal carotid.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We present a case of 6 years-old girl that suffered an intracranial transorbital penetrating injury with a wooden pencil that crossed from the medial edge of left orbit, transetmoidal and trans-sphenoidal, entering the right sellar region and leaving its end in contact with carotid artery (cavernous segment). After pre-surgical studies, foreign body removal was performed with endoscopic surgery + endovascular control in case of carotid injury. After removing the foreign body, a CSF fistula occurred and was repaired. Patient recovered adequately, without neurological deficit, without postoperative CSF fistula, without CNS infection or oculomotor alteration.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las lesiones traumáticas penetrantes transorbitarias-intracraneanas, son infrecuentes en población pediátrica, pudiendo ocurrir en el contexto de accidentes domésticos, deportivos o escolares. Pueden extenderse a la base del cráneo y comprometer estructuras vasculares como el seno cavernoso y carótida interna.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se presenta caso de niña de 6 años de edad, sufre lesión penetrante transorbitaria intracraneal con un lápiz de madera, con trayecto cruzado desde borde medial de órbita izquierda, transetmoidal y transesfenoidal, ingresando a región selar derecha e improntando a arteria carótida derecha (porción cavernosa). Luego de los estudios pre-quirúrgicos, se realizó extirpación de cuerpo extraño con cirugía endoscópica + control endovascular en caso de lesión carotidea. Posterior a resecar cuerpo extraño, se reparó fístula de LCR evidenciada intraoperatoriamente. Paciente se recuperó adecuadamente, sin déficit neurológico, sin fístula postoperatoria de LCR, sin infección del SNC ni alteración oculomotora.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torche Velez E, Rojas Vilarroel P, Vera Figueroa F, Vigueras Alvarez S. Lesión penetrante intracraneana transorbitaria, con compromiso de seno cavernoso en paciente pediátrico. Neurocirugia. 2022;33:377–382.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0270" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3188 "Ancho" => 2917 "Tamanyo" => 508573 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bone window tomography with a foreign body passing through the ethmoid sinuses from left to right (1.A). CT angiography of the brain shows contact between a foreign body and the right cavernous carotid artery (1.B). Bone 3D reconstruction, marked foreign body trajectory and its relationship with structures in the sellar region (1.C).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3623 "Ancho" => 2918 "Tamanyo" => 714222 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Neurovascular ward of Guillermo Grant Benavente Hospital (2.A). Angiography of the brain shows relationship of foreign body with carotid and cavernous sinus (2.B).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1987 "Ancho" => 2917 "Tamanyo" => 682611 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Endoscopic visualisation of foreign body (3.A). Gradual extraction of pencil from the base of the skull (3.B.I, 3.B.II and 3.B.III). Black arrow indicates CSF fistula through defect in the sellar floor caused by foreign body (3.C.I, 3.C.II and 3.C.III). Closure of dural defect with fat patch, nasoseptal flap and DuraSeal (3.D).</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 27932290 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. 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