{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:02Z","timestamp":1786125842635,"version":"build-2736575974"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T00:00:00Z","timestamp":1627689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND AND IMPORTANCE<\/jats:title>\n                    <jats:p>Orbitocranial penetrating injury (OPI) is associated with neurological, infectious, and vascular sequalae. This report describes unique application of an orbitofrontal craniotomy through a supraciliary approach to remove a wooden stick penetrating through the orbit and frontal lobe, postoperative management, and antimicrobial therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL PRESENTATION<\/jats:title>\n                    <jats:p>A 51-yr-old male presented after a tree branch penetrated beneath his eye. He had no loss of consciousness and was neurologically intact with preserved vision and ocular motility. Computed tomography (CT) and CT angiogram revealed an isodense hollow cylindrical object penetrating though the left orbit and left frontal lobe. The object extended into the right lateral ventricle, abutting the left anterior cerebral artery. There was minimal intraventricular hemorrhage without arterial injury. The patient was treated with broad-spectrum antimicrobial coverage. The foreign body was removed and the dural defect repaired via an orbitofrontal craniotomy through a supraciliary eyebrow incision. He was treated with an extended course of antimicrobial therapy, and after 18 mo remained neurologically intact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>OPI are a subset of penetrating brain injuries with potential for immediate injury to neurovascular structures and delayed complications including cerebrospinal fluid leak and infection. Treatment includes attempted complete removal of the foreign body and antimicrobial therapy. An orbitofrontal craniotomy through a supraciliary eyebrow incision may be effective in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opab259","type":"journal-article","created":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T21:00:15Z","timestamp":1627765215000},"page":"E386-E391","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Removal of a Penetrating Tree Branch in the Orbitofrontal Region\u2014A Unique Application of an Orbitofrontal Craniotomy Through a Supraciliary Brow Approach"],"prefix":"10.1227","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2052-7243","authenticated-orcid":false,"given":"Rupen","family":"Desai","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja I","family":"Srienc","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robi N","family":"Maamari","sequence":"additional","affiliation":[{"name":"John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip L","family":"Custer","sequence":"additional","affiliation":[{"name":"John F. Hardesty MD, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K","family":"Warren","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R","family":"Chicoine","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University in St. Louis, St. Louis, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,10]]},"reference":[{"issue":"6","key":"bib1-20250821","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/0090-3019(92)90109-Z","article-title":"Predictors of mortality in severely head-injured patients with civilian gunshot wounds: a report from the NIH Traumatic Coma Data Bank","volume":"38","author":"Aldrich","year":"1992","journal-title":"Surg Neurol"},{"issue":"3","key":"bib2-20250821","doi-asserted-by":"crossref","first-page":"395","DOI":"10.4103\/0974-2700.83871","article-title":"Management of penetrating brain injury","volume":"4","author":"Kazim","year":"2011","journal-title":"J Emerg Trauma Shock"},{"key":"bib3-20250821","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.wneu.2015.12.063","article-title":"Orbitocranial low-velocity penetrating injury: a personal experience, case series, review of the literature, and proposed management plan","volume":"87","author":"Mzimbiri","year":"2016","journal-title":"World Neurosurg"},{"issue":"3","key":"bib4-20250821","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1001\/archopht.1964.00970010348008","article-title":"Intracranial complications of penetrating orbital injuries","volume":"71","author":"Bard","year":"1964","journal-title":"Arch Ophthalmol"},{"issue":"5","key":"bib5-20250821","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.survophthal.2006.06.008","article-title":"Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases","volume":"51","author":"Turbin","year":"2006","journal-title":"Surv Ophthalmol"},{"issue":"6","key":"bib6-20250821","doi-asserted-by":"crossref","first-page":"697","DOI":"10.3171\/2019.6.PEDS19106","article-title":"Complete recovery following transorbital penetrating head injury traversing the brainstem: case report","volume":"24","author":"MacLean","year":"2019","journal-title":"J Neurosurg Pediatr"},{"issue":"3","key":"bib7-20250821","doi-asserted-by":"crossref","first-page":"321","DOI":"10.4103\/1793-5482.145092","article-title":"Transorbital penetrating brain injury by a wooden stick: a neuro-ophthalmologic emergency","volume":"11","author":"Behera","year":"2016","journal-title":"Asian J Neurosurg"},{"issue":"4","key":"bib8-20250821","doi-asserted-by":"crossref","first-page":"714","DOI":"10.3171\/jns.2001.95.4.0714","article-title":"Eyebrow incision for combined orbital osteotomy and supraorbital minicraniotomy: application to aneurysms of the anterior circulation. 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