Interdisciplinary endoscopic assisted surgery of a patient with a complete transorbital intracranial impalement through the dominant hemisphere

Transorbital injuries are common and represent about 24% to 45% of all penetrating head injuries in adults and children [1]. However, only <1% of the cases show a skullor brainpenetrating route with consecutive intracranial injuries [1, 2]. The direction and orbital entry route depends on the velocity of the impalement and the trajectory of the foreign body. In low-velocity injuries, the foreign body may be directed by the configuration of the orbital walls and enters most likely through the superior and inferior orbital fissures or the orbital canal [3]. In cases of higher-velocity impalements, the orbital wall may directly fracture following a perpendicular trajectory line. Here, we describe the first case in the literature of a complete impalement injury through the dominant hemisphere entering the inner orbital angle, fracturing the medial aspects of the skull base and leaving the skull contralaterally through the occipital bone, treated successfully in interdisciplinary cooperation via a combined transnasal–transcranial approach.