Sinonasal metallic foreign body penetration of the anterior cranial fossa

Abstract

Introduction: Intracranial foreign bodies have the potential to cause several devastating complications including CSF leak, meningitis, hydrocephalus, nerve or vessel injury, and even death [1,3,5]. These risks must be weighed against the risks associated with potential management options and techniques for removal. With the advent of endonasal anterior skull base techniques, safe and efficient options for surgical retrieval and skull base repair have become available [1,2,4]. Methods: In the present report, we present three cases involving metallic foreign bodies penetrating anterior cranial fossa via the sinonasal tract, and the management approaches employed. Results: The three cases involved [1] a migrated K-wire from nasal reconstruction in the remote past [2], an acute nail-gun injury, and [3] an impaled car antenna. A combined endoscopic and transcranial approach was performed in the former two cases, while in the latter, an EVD was placed due to elevated ICP after the foreign body had been withdrawn. Conclusion: Intracranial metallic foreign bodies may have significant potential morbidity. Recent advances in endonasal techniques for anterior skull base access may enhance outcomes through reduced morbidity and mortality, improved speed and precision, shorter hospital stays, and lower post-operative pain [1,2,4]. Technical nuances of these approaches and medical decision-making in the context of various neurosurgical considerations are discussed.