Transorbital Penetrating Intracranial Injury by Wooden Foreign Body: A Rare Case Report

Transorbital penetrating intracranial injury (TOPI) is a rare form of traumatic brain injury, often caused by high-velocity projectiles. However, non-missile penetrating injuries, particularly from wooden foreign bodies, are uncommon and pose diagnostic and therapeutic challenges due to their radiolucency and high risk of infection. We report the case of a 58-year-old Nepali male who sustained a TOPI after falling from a tree, with a wooden foreign body penetrating his right orbit and extending intracranially. The patient presented 6 days post-injury with persistent pain and bleeding but no neurological deficits. Imaging revealed a comminuted fracture of the superomedial orbital wall with intracranial extension, an intraorbital foreign body, and vascular compromise in the anterior cerebral artery (ACA) territory. Given the intracranial extension and vascular involvement, a multidisciplinary approach involving neurosurgery and ophthalmology was employed. The foreign body was successfully removed via a medial orbitotomy, and the patient was managed with broad-spectrum antibiotics. His postoperative course was uneventful, with no long-term complications. TOPI involving wooden foreign bodies presents diagnostic difficulties due to their variable CT attenuation and potential to mimic pneumocephalus. MRI is often required for definitive diagnosis, but in resource-limited settings, a combination of clinical evaluation and CT with angiography can guide management. Early surgical removal and infection control are critical for a favorable outcome. Various surgical approaches, including orbitotomy, transcranial, and transnasal endoscopic techniques, should be considered based on foreign body location and extent. This case underscores the importance of early recognition, multimodal imaging, and timely surgical intervention in managing TOPI. Despite the high-risk nature of such injuries, meticulous planning and prompt treatment can lead to excellent functional and neurological recovery.