Transorbital Penetrating Brain Injury Extending into the Prepontine Region: A Case Successfully Managed via Anterior Petrosectomy.

Abstract

Transorbital penetrating brain injuries are rare and may cause fatal damage depending on their trajectory. We report a case of a man in his 60s with a transorbital injury caused by wooden chopsticks extending to the prepontine region. Imaging demonstrated that the foreign bodies passed through the superior orbital fissure and cavernous sinus, reaching the prepontine region; however, no major vascular injury was identified. Emergency surgery using a frontotemporal craniotomy combined with anterior petrosectomy (Kawase approach) enabled wide exposure of the trajectory at the upper clivus and prepontine space, allowing for the safe removal of fragmented foreign bodies and adhering paper under direct visualization. Postoperatively, no carotid-cavernous fistula was detected; however, brainstem contusion resulted in severe neurological deficits, and the patient died from aspiration-related complications. This approach provides effective exposure for managing transorbital penetrating injuries extending to the upper clivus or prepontine space.