Faculty Collaboration Database

Transnasal Penetration of a Ballpoint Pen: Case Report and Review of Literature. World Neurosurg 2016 Dec;96:611.e1-611.e10

Date

09/20/2016

Pubmed ID

27641266

DOI

10.1016/j.wneu.2016.09.021

Scopus ID

2-s2.0-84992076952 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

BACKGROUND: Transnasal penetration by a nonmissile foreign body is a rare injury. Consequently, appropriate management remains controversial. We report a case of transnasal penetration by a ballpoint pen and review the literature. To our knowledge, this is the first living patient who sustained carotid artery damage from a transnasal penetrating intracranial injury.

CASE DESCRIPTION: A 56-year-old female presented with a ballpoint pen lodged through her left nostril. She exhibited right cranial nerve palsies (III, IV, VI, and V1). A computed tomography (CT) scan of the head revealed a foreign body in the left nasal cavity traversing the ethmoid/sphenoid and likely through the right superior orbital fissure and cavernous sinus, with the distal tip adjacent to the right atrium. CT angiography revealed nonopacification of the right internal carotid artery (ICA) from the mid-petrous segment to the ophthalmic segment. Subsequently, she underwent coil embolization of the proximal right ICA, followed by a right frontotemporal craniotomy with anterior temporal lobectomy to skeletonize the pen and right distal ICA, and finally clipping of the ICA distal to the pen and prompt transnasal endoscopic removal of the pen. There were no hemorrhagic complications. She awoke at her neurologic preoperative baseline.

CONCLUSION: Injuries such as the one described here should be managed through a multidisciplinary approach. The trajectory of the foreign body should be delineated through CT imaging, along with vascular imaging if appropriate. If there are signs of vascular injury, then attempts to maintain proximal and distal control are prudent to avoid hemorrhagic complications. This combined endovascular-endoscopic-open craniotomy approach has not been reported previously in the literature.

Author List

Nguyen HS, Oni-Orisan A, Doan N, Mueller W

Author

Wade M. Mueller MD Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Angiography, Digital Subtraction
Carotid Artery, Internal
Craniotomy
Embolization, Therapeutic
Endoscopy
Female
Foreign-Body Migration
Humans
Interdisciplinary Communication
Intersectoral Collaboration
Middle Aged
Nose
Self-Injurious Behavior
Temporal Lobe
Tomography, X-Ray Computed
Wounds, Stab