When a Transorbital Penetrating Brain Injury Reveals the Infratentorial Tumor: A Case Report and Technical Note

A 62-year-old man was referred for a transorbital injury. A preoperative computed tomography scanner confirmed an 8 cm long x 14 mm wooden piece penetrating the right orbit and perforating the anterior cranial base until the frontal lobe with no apparent prominent vascular injury. However, an unexpected posterior fossa tumor causing blocked hydrocephalus was unveiled. Extraction of the wooden stick was safely achieved after intracranial exploration followed by meticulous cleaning and careful watertight closure to prevent cerebrospinal fluid (CSF) leakage. Except the right eyesight loss, he initially recovered well, were it not for his hard-to-treat hydrocephalus. What at the time of its discovery seemed to be a less important but very likely the indirect cause of its injury, became unexpectedly problematic. Despite all CSF diversion procedures, the patient worsened gradually. Neither a failed attempt to remove the tumor due to the fourth ventricle floor broad infiltration nor the posterior fossa decompressive craniectomy succeeded in improving his neurological status. Despite the diagnosis of a grade II ependymoma, the tumor demonstrated an aggressive radiological behavior with an intense edema of the brainstem, possibly the cause of his drowsiness. Unfortunately, he died of tumor progression solely 52 days after his transorbital injury.