Transorbital penetrating brainstem injury by a chopstick with major vessel proximity: staged extraction under endovascular standby and serial vascular follow-up

Transorbital penetrating head trauma is rare but carries high mortality due to the risk of intracranial vascular injury and infection. Early vascular assessment and careful procedural planning are critical. A woman in her fifties sustained transorbital penetration by a chopstick that traversed the brainstem and extended to the posterior fossa. CT angiography demonstrated proximity to the cavernous segment of the right internal carotid artery and the posterior cerebral artery without active extravasation. Under endovascular standby with proximal balloon preparation, the foreign body was removed in a conventional angiography suite without craniotomy. Serial angiography and MRA revealed transient vascular irregularity that gradually resolved, documenting spontaneous vascular healing without the use of antithrombotic therapy. Post-treatment MRI demonstrated parenchymal injury along the penetrating trajectory without evidence of abscess formation. This case illustrates that in angiographically stable but anatomically high-risk transorbital penetrating injuries, planned extraction under endovascular standby may be a feasible option in carefully selected cases. Serial vascular follow-up is essential to detect delayed vascular changes and to confirm spontaneous vascular healing.