Penetrating stab injury extending from the temporal region to the orbital apex and ethmoidal cells – A unique case report and review of the literature

Abstract

Background: Nonmissle penetrating brain injuries (PBIs) are rare in civilian settings and present significant diagnostic and surgical challenges, particularly when involving the skull base and orbit. Case Description: A 28-year-old male sustained a penetrating stab wound to the left temporal region following an interpersonal assault. Imaging revealed a transcranial trajectory extending to the orbital apex and ethmoidal cells in proximity to the internal carotid artery and optic nerve, without definitive vascular injury. The patient underwent emergency frontotemporal craniotomy with controlled removal of the foreign body and evacuation of intracranial hematoma. Postoperatively, neurological deterioration necessitated reoperation and placement of an external ventricular drain. Following intensive care management, the patient stabilized and was transferred to a specialized rehabilitation center. Conclusion: PBIs require rapid imaging, careful surgical planning, and multidisciplinary management. Even in the absence of major vascular injury, involvement of the skull base necessitates vigilant monitoring for complications.