Orbitocranial Low-Velocity Penetrating Injury: A Personal Experience, Case Series, Review of the literature, and Proposed Management Plan.
BACKGROUND
Orbitocranial penetrating injuries (OPI) are an unfamiliar subset of head injury and are particularly rare in clinical practice. They are usually the result of falls or motor vehicle collisions and occur more commonly in children, who are prone to trauma while playing games improperly.


METHODS
We present a retrospective review of 5 cases of OPI treated in the Neurotrauma Department at Xiangya Hospital of Central South University in the last 5 years. Also, we performed comprehensive literature searches using Web of Science and the terms "orbitocranial injury," "penetrating ocular trauma," "penetrating orbital trauma," and "transorbital chopstick penetrating injury" to search for presentation, mechanism of injury, and management of transorbital penetrating injury.


RESULTS
In 2 patients, there was right internal carotid artery occlusion while in other 2 patients, the penetrating objects reached the brainstem through the cavernous sinus, resulting in orbital apex syndrome. All patients underwent a thorough physical examination followed by diagnostic imaging. The cases were successfully managed surgically by removing the foreign bodies through their trajectories.


CONCLUSIONS
Computed tomography, magnetic resonance imaging, and computed tomography angiography are key imaging modalities that are frequently used to determine the course of the foreign object and the extent of brain tissue injury as well as to rule out vascular injury in these types of cases. Early surgical exploration by a multidisciplinary team approach is essential to attain good recovery and a favorable outcome.
['Mzimbiri|Juma M|JM|', 'Li|Jian|J|', 'Bajawi|Mdaish A|MA|', 'Lan|Song|S|', 'Chen|Fenghua|F|', 'Liu|Jinfang|J|']
D000328:Adult D001930:Brain Injuries D001933:Brain Stem D002343:Carotid Artery, Internal D002426:Cavernous Sinus D002533:Cerebral Angiography D002675:Child, Preschool D002681:China D003251:Constriction, Pathologic D017809:Fatal Outcome D005547:Foreign Bodies D015600:Glasgow Coma Scale D020197:Head Injuries, Penetrating D006801:Humans D002534:Hypoxia, Brain D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D019635:Neurosurgical Procedures D009915:Orbit D012886:Skull D014057:Tomography, X-Ray Computed D016896:Treatment Outcome
Chopstick Transorbital penetrating injury Brainstem Cavernous sinus Orbital apex syndrome Cerebral angiography ICA occlusion