Unusual pathway of intracranial foreign bodies in transorbital-penetrating injury: Exploring uncharted routes

Transorbital-penetrating injuries are rare but can be severe, often affecting deeper skull structures, including the brain. They account for 4.5% of orbital pathologies and 0.04% of head injuries, with foreign objects rarely traversing ocular structures into the cranial cavity. A 26-year-old man sustained an injury from a wooden stick while cutting wood, with a 27 cm foreign body (FB) extending into the cranial cavity. CT and angiography revealed fractures in the left orbital floor, medial wall, maxillary sinus, ethmoid air cells, and sphenoid sinuses, with the object bifurcating into the right temporal lobe and the nasopharynx. After confirming the absence of vascular involvement, the intracranial portion was removed via right frontotemporal craniotomy, and the extra-cranial portion was extracted through the intraorbital region under general anesthesia. Postoperatively, the patient was conscious and oriented, with a visual acuity of 3/60. Managing these injuries requires a multidisciplinary approach and advanced imaging, with early rehabilitation essential for recovery.