August 15, 2025Open Access

Management and Outcomes of Non-Missile Penetrating Brain Injury Involving the Anterior Skull Base: A Case Report and Systematic Review

WCWojciech CzyżewskiMedical University of Lublin MSMichał SzymoniukMedical University of Lublin JLJakub LitakMedical University of Lublin

Key Points

Operative management was required for 90.2% of patients with non-missile penetrating brain injury, indicating a high level of intervention needed.
Among 40 patients with penetrating brain injury, 47.4% did not achieve full neurological recovery, highlighting the serious nature of these injuries.
The case report details a 20-year-old male's experience with transorbital injury caused by a crossbow, illustrating the trauma's complexity.
Collaboration among neurosurgeons, ENT surgeons, and other specialists is essential to improve outcomes in patients with this type of traumatic brain injury.

Abstract

Introduction: Non-missile penetrating brain injury (PBI) involving the anterior skull base constitutes a rare subclass of traumatic brain injury in civilians. Management of this type of trauma is poorly described in the literature, with only case series and reports available. Materials and Methods: A systematic search was conducted across PubMed, Scopus, and Web of Science databases. The study included reports of adult patients with non-missile PBI with foreign bodies crossing the anterior skull base, published between the years 2000 and 2024. The patients were divided into three groups based on the entry point of foreign bodies: transorbital, transmental, and transnasal injuries. The obtained data were analyzed through descriptive statistics. A case report of a 20-year-old male following PBI involving the anterior skull base caused by suicidal self-shooting with a crossbow is presented. Results: A total of 17 articles reporting 40 patients and the current case were included. The mean age of the patients was 37.4 ± 13.1 years, and 92.7% of them were male. Transorbital injury was the dominant type of PBI (29 cases), followed by transmental injury (7 cases) and transnasal injury (5 cases). A total of 37 patients (90.2%) were managed operatively due to retained foreign bodies after PBI. Antibiotic prophylaxis was implemented in 33 cases (80.5%), mostly in transorbital (93.1%) and transnasal (100%) PBI. In seven reported cases, antiepileptic drugs were preventively administered. At the last follow-up, 18 patients (47.4%) did not fully recover neurological functions, with vision loss as the most common deficit. Conclusions: Management of non-missile PBIs involving the anterior part of the skull base is complex, challenging, and often requires a multidisciplinary team including neurosurgeons, ENT surgeons, ophthalmologists, and maxillofacial surgeons. In this type of traumatic brain injury, following proper management may lead to favorable outcomes with minimal neurological deficits.

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