Removal of a nonmissile, transorbital, intracranial glass shard: illustrative case.

Background: The management of nonmissile penetrating head injuries is not well established given the heterogeneity of injuries described. The authors describe the management of a patient who presented to their institution along with a review of the literature.

Observations: The glass shard was removed in the operating room with the ophthalmology team without complication. A diagnostic cerebral angiogram was also obtained in an urgent and delayed fashion. A total of 53 studies with 90 patients were included. The mean age was 27 years, and 86% of subjects were male. The frontal region violated via metal spike was the most common location of injury. Prophylactic antibiotics and antiepileptic drugs were administered in 68% and 24%, respectively. Craniotomy for removal was performed in 82% of cases and infection occurred in 6%.

Lessons: Emergency CT angiography should be obtained when concern for vascular injury based on trajectory or significant depth of penetration exists. Immediate administration of prophylactic antibiotics and AEDs should be completed. Diagnostic angiography for suspicion of vessel injury in an urgent and delayed fashion should be performed. Removal of intracranial objects should only occur in the operating room. Immediate postoperative CT should be utilized to rule out worsening of intracranial injury. https://thejns.org/doi/10.3171/CASE24851.