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Case Report
Available online 3 March 2022
Transorbital penetrating intracranial injury, with cavernous sinus involvement
Lesión penetrante intracraneana transorbitaria, con compromiso de seno cavernoso en paciente pediátrico
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Esteban Torche Velez, Pablo Rojas Vilarroel, Franco Vera Figueroa
Corresponding author
franco.verafigueroa@gmail.com

Corresponding author.
, Sebastián Vigueras Alvarez
Hospital Guillermo Grant Benavente (Hospital Regional de Concepción), Concepción, Chile
Received 26 January 2021. Accepted 20 August 2021
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Abstract

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.

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.

Keywords:
Penetrating orbitocranial trauma
Cavernous sinus lesion
Cavernous carotid injury
Foreign body resection of the cranial base
Neuroendoscopy
Endoscopic resection of intracranial foreign body
Resumen

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.

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.

Palabras clave:
Trauma penetrante orbitocranial
Lesión de seno cavernoso
Lesión de carótida cavernosa
Resección cuerpo extraño base de cráneo
Neuroendoscopia
Resección endoscópica cuerpo extraño intracraneal

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