Use of Pterional Craniotomy for Removal of Penetrating Object: Case Report and Surgical Video.

Abstract

Penetrating injuries are dangerous because they can damage intracranial structures. Removal of the object carries this same risk of injury, so neurosurgeons often visualize the injury via craniotomy during removal. This report illustrates the case of a 41-year-old man who had a penetrating injury with a knife that started in the left nasal passage and extended to the parasellar region. Computed tomography angiography revealed an associated sphenoid fracture and showed the tip of the knife within the parasellar space with preservation of the internal carotid artery, ophthalmic artery, optic nerve, and pituitary gland. The patient was taken to the operating room for a right pterional craniotomy and the knife was removed in the operating room in a combined effort between neurosurgery and otorhinolaryngology. The patient progressed well without complications postoperatively and was discharged 5 days later. We provide a report with video showing our surgical approach for removal of a penetrating object through the tuberculum sellae.