Bilateral trans-orbital penetrating cranial injury: Case report and literature review

A rare case of bident shaped barbed spear injury to the cranial base in a 14year old male with a rare mechanism of injury, which was treated operatively with good recovery. Clinical and imagery review of a cranial penetrating trauma resulting from a bi-prong barbed spear which pierced the cranium, dura mater and frontal lobe parenchyma traversing the orbital cavity without injury to the globe or critical neurovascular structures. The patient underwent bifrontal craniotomy to remove the bident shaped barbed metallic spear head complex. This was done retrograde to its route of entry. He was hospitalized 2 weeks post-surgery and discharged. During outpatient follow up he manifested no neurologic deficits. Transorbital intracranial injuries are rare lesions more so, non-assault related bilateral transorbital injury from a bi-prong barbed spear. Maximal injury occurs when barbed spears are retrieved by retracing their route of entry. In this case however, retrograde retrieval was adjudged the safest route after a bifrontal craniotomy flap was turned. There was no morbidity.