Orbitocranial penetration by a fern: case report

Cranial and orbitocranial penetration by organic foreign material is not infrequent. It is important to identify whether penetration has occurred and to localize and remove the organic foreign material. We report a 15-month-old patient who suffered orbitocranial penetration with the stem of a fern. The stem passed through the orbit, exiting via the superior orbital fissure. It continued through the middle cranial fossa to end in the posterior cranial fossa. The patient underwent surgery, and a modified Dolenc procedure was performed. The foreign body was identified in the prepontine cistern and was removed. An extradural approach was performed to the cavernous sinus and superior orbital fissure, and the remaining foreign body was removed. Retained intracranial wood should be removed. The radiological diagnosis can be difficult, and magnetic resonance imaging is the investigation of choice. Magnetic resonance imaging may not detect some cases of organic foreign material penetration.