Skull Base 2010; 20(6): 487-490
DOI: 10.1055/s-0030-1261264
CASE REPORT

© Thieme Medical Publishers

Management of a Long-Standing Organic Intracranial Foreign Body

Aaron M. Wieland1 , 2 , William T. Curry3 , 5 , Marlene L. Durand4 , 5 , Eric H. Holbrook1 , 2
  • 1Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
  • 2Department of Otology and Laryngology, Boston, Massachusetts
  • 3Department of Neurosurgery, Boston, Massachusetts
  • 4Division of Infectious Disease, Harvard Medical School, Boston, Massachusetts
  • 5Massachusetts General Hospital, Boston, Massachusetts
Further Information

Publication History

Publication Date:
11 June 2010 (online)

ABSTRACT

Organic foreign bodies of the skull base are an uncommon problem with the potential for serious morbidity that present complicated treatment dilemmas best managed by a multidisciplinary approach. A 58-year-old male presented to the emergency department with fevers and mental status changes and was found to have bacterial meningitis. Computed tomography of the sinuses revealed two adjacent defects of the ethmoid roof with associated soft tissue density concerning for an encephalocele. He had a remote history of a penetrating left maxilla injury with a stick 13 years earlier. An attempted endoscopic repair of the defects revealed a pulsating splinter of wood emanating from the ethmoid roof defect. Neurosurgery and infectious disease were consulted and several wood fragments were removed endoscopically from the intracranial space. The skull base defects were closed using a septal cartilage underlay and free mucosal overlay graft. The patient has done well in follow-up with no evidence of cerebrospinal fluid leak. Organic foreign bodies from skull base trauma can have a delayed presentation and require a multidisciplinary team approach. In the appropriate setting endoscopic removal is a minimally morbid option.

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Aaron WielandM.D. 

Massachusetts Eye and Ear Infirmary

243 Charles Street, Boston, MA 02114

Email: aaron_wieland@meei.harvard.edu

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