Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report

RATIONALE: Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections. PATIENT CONCERNS: We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve. DIAGNOSIS: Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery. TREATMENT: Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments. OUTCOMES: Left eye vision was lost. The 1-year follow-up was uneventful. TAKE-AWAY LESSONS: Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.