Cavernous sinus embolisation prior to removal of penetrating foreign body in a 6-year-old child

Transorbital penetrating foreign bodies are extremely rare in children and may penetrate the cavernous sinus or the underlying internal carotid artery. Parent vessel sacrifice and temporary balloon occlusion are feasible options for managing arterial injury during removal of the foreign body. Even i...

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Bibliographic Details
Published in:BMJ case reports 2020-12, Vol.13 (12), p.e237301
Main Authors: Bhatia, Kartik D, French, Heath, Olsson, Gemma, Tumuluri, Krishna
Format: Article
Language:English
Subjects:
Accidental Injuries
Balloon Occlusion - methods
Bicycling
Cardiac arrhythmia
Carotid arteries
Carotid Artery, Internal - surgery
Case Report
Case reports
Cavernous Sinus - pathology
Child
Children & youth
Computed Tomography Angiography
Dissection
Embolization
Fistula
Foreign bodies
Foreign Bodies - complications
Foreign Bodies - surgery
Head Injuries, Penetrating - surgery
Humans
Male
Medical imaging
Neurosurgery
ophthalmology
Orbit - blood supply
Orbit - pathology
Orbit - surgery
paediatrics
Pediatrics
Sinuses
trauma CNS /PNS
Veins & arteries
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Summary:Transorbital penetrating foreign bodies are extremely rare in children and may penetrate the cavernous sinus or the underlying internal carotid artery. Parent vessel sacrifice and temporary balloon occlusion are feasible options for managing arterial injury during removal of the foreign body. Even in the absence of arterial injury, the ophthalmologist may encounter significant bleeding from the cavernous sinus deep in their operative field that is difficult to control. We present a case of a 6-year-old child with a stick penetrating the left superior orbit to enter the cavernous sinus but sparing the internal carotid artery. We describe the first reported experience of prophylactic coil embolisation of the cavernous sinus to minimise intraoperative bleeding during transorbital removal of a foreign body with an excellent clinical outcome.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2020-237301