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Case report
Cavernous sinus embolisation prior to removal of penetrating foreign body in a 6-year-old child
  1. Kartik D Bhatia1,
  2. Heath French2,
  3. Gemma Olsson2 and
  4. Krishna Tumuluri3
  1. 1Department of Medical Imaging, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2Department of Neurosurgery, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  3. 3Department of Ophthalmology, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  1. Correspondence to Dr Kartik D Bhatia; kartik.bhatia{at}health.nsw.gov.au

Abstract

Transorbital penetrating foreign bodies are extremely rare in children and may penetrate the cavernous sinus or the underlying internal carotid artery. Parent vessel sacrifice and temporary balloon occlusion are feasible options for managing arterial injury during removal of the foreign body. Even in the absence of arterial injury, the ophthalmologist may encounter significant bleeding from the cavernous sinus deep in their operative field that is difficult to control. We present a case of a 6-year-old child with a stick penetrating the left superior orbit to enter the cavernous sinus but sparing the internal carotid artery. We describe the first reported experience of prophylactic coil embolisation of the cavernous sinus to minimise intraoperative bleeding during transorbital removal of a foreign body with an excellent clinical outcome.

  • paediatrics
  • ophthalmology
  • neurosurgery
  • trauma CNS /PNS

http://dx.doi.org/10.1136/bcr-2020-237301

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    Footnotes

    • Contributors KDB was the paediatric interventional neuroradiologist involved in the case, acquired the angiographic imaging and wrote the first draft of the manuscript. HF was part of the neurosurgical team involved in the case, provided clinical data and assisted with editing of the manuscript. GO was the neurosurgeon involved in the case, provided clinical data and assisted with editing of the manuscript. KT was the ophthalmologist involved in the case, provided clinical data and assisted with editing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.