Klinički asimptomatska intrakranijalna ozljeda nastala transorbitalnim prodorom projektilnoga stranog tijela

Marijan Kovačić, Ivan Kovačić, Ivica Francišković, Maja Grgec Dragičević

Cilj: U ovom radu prikazali smo rijedak slučaj transorbitalne intrakranijalne prodorne ozljede, naše postupke dijagnostike, liječenje i konačni ishod. Bolesnik i metode: Bolesnik 38 godina star, na trijažnom pregledu je imao desno periorbitalnu ozljedu, podljev i oteklinu gornjeg kapka te manju razderotinu kože i prolaps spojnice. Nije imao gubitak svijesti, vida niti neurološki deficit. Temeljem dobivenih podatka da je orbitalnu ozljedu zadobio kod košnje raslinja, osim kliničkog pregleda, proveli smo i radiološku obradu. Kao prvu metodu radiološke dijagnostike izvršili smo kompjutoriziranu tomografiju. Otkriven je metalni artefakt zaboden u medijalni dio krova orbite s djelomičnim probojem u intrakranij. Nakon provedene profilakse tetanusa i primjene antibiotika, pristupili smo uklanjanju stranog tijela. Odabrali smo vanjski transorbitalni put iznad ulazne rane. Prikazali smo orbitalni dio stranog tijela i bez primjene grube sile izvadili komad žice. Nastali rupičasti defekt kosti zatvorili smo koštanim voskom. Rezultat: Oporavak bolesnika bio je brz, bez neuroloških i okulističkih ispada. Nismo zamijetili prisutnost ranih i kasnih komplikacija operacijskog zahvata. Zaključak: Ova ozbiljna, ponekad i po život bolesnika opasna ozljeda, može imati uspješan ishod ako se multidisciplinarnim pristupom rano postavi dijagnoza, koristi ciljano dijagnostičko snimanje, izvrši kvalitetno kirurško planiranje, zahvat i poslijeoperacijsko liječenje.

Objective: In this paper, we present a rare case of transorbital intracranial penetrating injury, our diagnostic procedures, treatment, and final outcome. Patient and methods: A 38-year-old patient on triage examination had right periorbital injury, bruising and swelling of the upper eyelid, minor skin laceration, and joint prolapse. He had no loss of consciousness, vision or neurological deficit. Based on the data that he had suffered an orbital injury when mowing the plants, in addition to clinical examination we performed radiological processing. As the first method of radiological diagnostics we performed computed tomography. A metal artifact was found stuck in the medial part of the roof of the orbit with a partial penetration into the intracranium. After tetanus prophylaxis and antibiotic administration we proceeded to remove the foreign body. External transorbital pathway above the entrance wound was selected. We exposed the orbital part of the foreign body, and without applying brute force removed a piece of wire. The resulting perforated bone defect was closed with bone wax. Results: The patient’s recovery was rapid, with no neurological or ocular outbursts. We did not notice the presence of early and late complications of the operation. Conclusion: This serious, sometimes life threatening injury, can have a successful outcome if a multidisciplinary approach is used to diagnose early, perform targeted diagnostic imaging, quality surgical planning and postoperative treatment.