Get into an argument with someone
Chopsticks are inserted into the eye sockets
Recently, the Emergency Medicine Department of zhejiang university second hospital received a patient who had an argument with someone in the canteen and was inserted into his right eye by a pair of chopsticks. The patient was also very impulsive, and immediately pulled out the chopsticks, but the angle of force was not right, and the two chopstick heads were broken, leaving them in the eye sockets, and the blood flowed non-stop, and the situation was critical.
Yan Wei, deputy chief physician of neurosurgery, found that the patient's right eye had gone completely blind when examining the patient in the emergency room.
CT of the skull shows that most of the chopstick head is located in the orbit, but its deepest part has passed through the supraorbital fissure and entered the skull, compressing the internal carotid artery.
Supraorbital fissures
Internal carotid artery
Supraorbital fissures are many of the pores that connect the nerves that control the eyeball to the brain, and chopsticks passing through this foramen are highly likely to damage these nerves. The internal carotid artery is the largest artery in the skull, and once it ruptures and bleeds, it can cause fatal and serious consequences.
The patient's condition is very critical, on the one hand, the aorta is compressed, and at any time, it may be life-threatening to bleed, and if the arterial compression is not smooth, it may also cause a wide range of cerebral infarction; on the other hand, the chopsticks are placed in the orbit, and there will be infection over time, and bacteria may enter the skull and cause serious consequences.
Preoperative multidisciplinary discussion
Develop three surgical protocols
The patient's condition is complex, and the top priority is to remove the chopstick head. However, the biggest risk of taking chopsticks is that the internal carotid artery bleeds heavily, and once the bleeding needs to be treated immediately, otherwise it will be life-threatening within a few minutes; in addition, how to accurately find chopsticks in the swollen eye socket is also very difficult.
The Department of Neurosurgery convened doctors from the Department of Emergency Medicine, Ophthalmology, Anesthesia Surgery, Medical Imaging, Ultrasound medicine and intensive care units to discuss surgical options. After multidisciplinary discussion, it is believed that the patient's right eye is seriously damaged and difficult to recover, and the first goal is to remove the chopsticks under the premise of ensuring the safety of the patient's life.
According to the injury from small to large, the team formulated three extraction protocols: transorbital, transnasal and craniotomy.
Transorbital
Transorbital proto-injury approach surgery is minimal, but it is difficult to find the chopstick head due to swelling of the orbital tissue.
Nasal
Nasal surgery is secondary, but there is a risk of CSF leakage.
Craniotomy
Craniotomy is easy to find foreign bodies, but the damage is large and increases the risk of infection. Regardless of the method of removal, it is necessary to be prepared for a major bleeding in the artery.
The team decided to perform the procedure in the compound operating room, where endovascular interventional therapy, microscopic craniotomy and endoscopic transnasal surgery could be performed simultaneously.
Before removing the chopstick head, do cerebral angiography to clarify the arterial condition, and place a guide wire catheter to the site of vascular compression, in case of arterial rupture and bleeding, you can immediately insert it into the balloon through the blood vessel to stop the bleeding and repair the blood vessel.
Chopstick head removed during surgery (left)
Postoperative follow-up examination did not reveal carotid artery bleeding, and the indentation became shallow (right)
Fortunately, the first surgical protocol was implemented successfully. The operation was completed by the team of Yan Wei and Chen Ting, a sub-specialty of neurosurgery and critical care, and assisted by equipment such as B ultrasound in the operation, the team successfully found and removed the residual chopsticks in the orbit, and there was no major bleeding during the extraction process. Cerebral angiography and CT were reviewed again immediately during the operation, and no internal carotid artery bleeding was seen, and the indentation of the artery was shallow. Thanks to the extensive experience of the neurosurgery team and the advanced conditions of the compound operating room, patients avoid complex and painful craniotomy.
After the operation, the doctor strengthened the anti-inflammatory treatment of the patient, the patient did not show obvious signs of infection, and no false aneurysm was seen in the CTA 1 week after the operation. The patient was successfully discharged from the hospital, but unfortunately the vision in his right eye cannot be restored and he has now returned to work.
Neurotic critical subspecialty
As the birthplace of neurosurgery in the province, Zhejiang University ranks among the top five in the national specialty ranking in terms of comprehensive strength, and the sub-professional team of neuro-acute and critical disease has accumulated rich experience in the treatment of various serious head injuries, cerebral hemorrhage and post-craniotomy complications. Especially in the treatment of severe trauma, it has always been at the forefront of the country. Neurosurgery, together with multidisciplinary teams from the Department of Emergency Medicine, Intensive Care Unit, Ophthalmology, and Oral Surgery, has successfully treated many dangerous cases of cranial penetrating injury in recent years.
Image source: Zhejiang Ershenwai Weekly
Some of the pictures are easy to cause discomfort, they have been coded, and they are displayed after clicking
A patient with a threaded tube cranial penetration injury was removed from life-threatening conditioning.
The folding knife was stabbed into the skull and successfully removed.
The blade is pierced through the orbit and successfully removed.
The bamboo was pierced into the orbit into the skull and successfully removed.
The steel hook is inserted into the orbital skull and is successfully removed.
The brazing is passed through the oropharynx into the skull and successfully removed
In the event of such an accident in real life, you should seek medical attention immediately and then transfer to a medical center with sufficient strength if possible. It is recommended that appropriate treatment measures be taken by a professional team after relevant examination and assessment, and foreign bodies should not be easily removed by themselves, so as not to aggravate the injury.
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