Citation

Nussbaum ES, Graupman P, Goddard JK, Kallmes KM. J. Neurosurg. Pediatr. 2018; 21(3): 270-277.

Affiliation

Duke University School of Law, Durham, North Carolina.

Copyright

(Copyright © 2018, American Association of Neurological Surgeons)

DOI

10.3171/2017.8.PEDS17320

PMID

29271732

Abstract

The authors describe a 14-year-old boy presenting with an orbitocranial penetrating injury (OPI) from a metallic air gun pellet to the left eye who developed hemiparesis and speech difficulty due to migration of the pellet to the left middle cerebral artery. They highlight the potential complications associated with both OPIs and intravascular foreign body migration and occlusion by describing the patient's presentation, results of imaging evaluation, and the combined endovascular treatment and extracranial-intracranial bypass, which resulted in rapid restoration of blood flow and full neurological recovery with intact vision. Based on this case and a review of the literature on intracranial foreign body migration with resultant vascular occlusion, the authors recommend that complex OPIs be treated at centers that offer both neuroendovascular and neurovascular surgical capabilities on an urgent basis to manage both the primary injury and potential secondary vascular compromise.

Language: en

Keywords

CCF = carotid cavernous fistula; EC-IC = extracranial-intracranial; ICA = internal carotid artery; MCA = middle cerebral artery; OPI = orbitocranial penetrating injury; STA = superficial temporal artery; extracranial-intracranial bypass; orbitocranial penetrating injury; pellet embolus; stroke; trauma