THE NONSURGICAL MANAGEMENT OF A PENETRATING ORBITOCRANIAL INJURY REACHING THE BRAIN-STEM - CASE-REPORT

Penetrating and perforating periorbital puncture wounds by lead pencil s are not rare, but ones that reach the brain stem are extremely unusu al. We recently treated a patient with of this type of injury. A newly sharpened lead pencil was accidentally introduced through the subconj unctiva at the inner canthus of the right eye. It passed along the med ial border of the globe transorbitally and went through the superior o rbital fissure into the temporal fossa, then continued through the lat eral side of the sella and posterior clinoid, reaching the brain stem. The entire pencil was removed inch by inch without incident under CT control. Meanwhile, the operative team remained ready in case of emerg ency bleeding. The patient's postoperative course was uneventful, but the initial neurologic deficit of the patient remained fixed.