Minimal Invasive Transnasal Endoscopic Removal of Intracranial Foreign Body after Airbag Deployment

Kovacs N1*, Zsolt V2 , Toth-Molnar E3 , Foldi J4 , Gyura E4 , Bella Z5 and Barzo P1

Department of Neurosurgery, University of Szeged, Hungary 2 Department of Traumatology, University of Szeged, Hungary 3 Department of Ophthalmology, University of Szeged, Hungary 4 Department of Anesthesiology and Intensive Therapy, University of Szeged, Hungary 5 Department of Otorhinolaryngology, University of Szeged, Hungary

^*Correspondance to: Nimrod Kovacs 

 PDF  Full Text DOI: 10.25107/2474-1647.3111

Abstract

Introduction: Airbag induced injuries such as skull and cervical spine fractures, epidural and subdural hematomas, atlanto-occipital dislocations or brainstem lacerations are already documented in published literature, however, no previous case have been published about a penetrating foreign body (a coin) of the skull base following airbag deployment. On the other hand, removal of an intracranial foreign body is very dangerous and difficult, or even if it possible and necessary requires open surgery in most of the cases. In this article we present the minimal invasive, Transnasal removal of a coin from the intracranial, frontonasal region using high-resolution endoscopy combined with image-guided navigation. Case Report: A 59-year-old male was brought to the emergency department by ambulance after being involved in a car accident. He suffered a penetrating injury by a coin that was placed on the car?s airbag at the moment of the accident. Upon the airbag being deployed the foreign body entered the skin through the right lower eyelid, crossing the orbital cavity, ethmoid cells, sphenoid sinus and the anterior part of the planum sphenoidale (roof of the sphenoid sinus) at an equal distance of 2 mm from the two internal carotid arteries, extending into the intracranial space, without injuring the pituitary stalk and the chiasm. We proceeded to remove the coin endoscopically using a Transnasal transseptal transsphenoidal approach under general anesthesia. The dura was closed with a multilayer skull base reconstruction technique using two layers of abdominal free fat and nasal septal mucoperiosteal flap. A lumbar drain was inserted for 9 days to divert the flow of the CSF, and to decrease the pressure at the leak site and to allow it to heal. There were no postoperative complications, nor CSF rhinorrhea. The patient was discharged 10 days after the operation. Conclusion: To our knowledge, this is the first case in published literature of a penetrating foreign body of the skull base, extending into the intracranial cavity following airbag deployment. Secondly, in some dedicated cases, a minimal invasive endoscopic approach should be considered as an alternative to anterior craniotomy if access is possible when foreign bodies from the skull base area need to be removed. This procedure is efficient, safe and minimally invasive.

Keywords

Intracranial foreign body; Coin; Airbag induced injury; Endoscopic approach; Skull base reconstruction

Cite the article

Kovacs N, Zsolt V, Toth-Molnar E, Foldi J, Gyura E, Bella Z, et al. Minimal Invasive Transnasal Endoscopic Removal of Intracranial Foreign Body after Airbag Deployment. Clin Surg. 2021; 6: 3111.