Air gun orbitocranial penetrating injury: emergency endovascular treatment and surgical bypass following pellet migration to middle cerebral artery: case report

J Neurosurg Pediatr. 2018 Mar;21(3):270-277. doi: 10.3171/2017.8.PEDS17320. Epub 2017 Dec 22.


The authors describe a 14-year-old boy presenting with an orbitocranial penetrating injury (OPI) from a metallic air gun pellet to the left eye who developed hemiparesis and speech difficulty due to migration of the pellet to the left middle cerebral artery. They highlight the potential complications associated with both OPIs and intravascular foreign body migration and occlusion by describing the patient's presentation, results of imaging evaluation, and the combined endovascular treatment and extracranial-intracranial bypass, which resulted in rapid restoration of blood flow and full neurological recovery with intact vision. Based on this case and a review of the literature on intracranial foreign body migration with resultant vascular occlusion, the authors recommend that complex OPIs be treated at centers that offer both neuroendovascular and neurovascular surgical capabilities on an urgent basis to manage both the primary injury and potential secondary vascular compromise.

Keywords: CCF = carotid cavernous fistula; EC-IC = extracranial-intracranial; ICA = internal carotid artery; MCA = middle cerebral artery; OPI = orbitocranial penetrating injury; STA = superficial temporal artery; extracranial-intracranial bypass; orbitocranial penetrating injury; pellet embolus; stroke; trauma.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Cerebral Angiography
  • Endovascular Procedures / methods*
  • Foreign-Body Migration / diagnostic imaging
  • Foreign-Body Migration / etiology
  • Foreign-Body Migration / surgery*
  • Head Injuries, Penetrating / diagnostic imaging
  • Head Injuries, Penetrating / etiology*
  • Head Injuries, Penetrating / surgery*
  • Humans
  • Male
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / surgery*
  • Tomography, X-Ray Computed
  • Wounds, Gunshot / complications*