Percutaneous endoscopic removal of a residual foreign body at the orbital-cranial region after transorbital penetrating injury:a novel minimally invasive technique

Background: The orbit is susceptible to traumatic injuries, and surgical management of transorbital penetrating injury with foreign body retention is challenging due to the associated risks of nervous and vascular injury. Application of multiple imaging modalities is helpful for the preoperative surgical planning, and technical advances in percutaneous endoscopy would render the surgical approach even less invasive. Case presentation: We present a 60-year-old female patient with a transorbital penetrating injury (TPI) caused by a bamboo stick in her right eye. The bamboo stick was initially pulled out at the emergency room but, 1 month later, massive bleeding from her nose and mouth occurred. CT and CTA revealed a foreign body in the right orbito-cranial region and a traumatic aneurysm at the right internal carotid artery. Endovascular embolization was first delivered to treat the aneurysm, and the remains of the bamboo stick were completely removed with a percutaneous endoscope. The patient was discharged 1 week later. Conclusions: A careful preoperative examination by multiple imaging modalities, e.g., CT, MRI, and DSA are essential for the correct diagnosis and surgical planning for the patient with a TPI. We minimised the associated risks of vascular and nervous injuries during foreign body removal by sequential application of the endovascular intervention and percutaneous endoscopic technique.