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Cent Eur Neurosurg 2009; 70(1): 48-51
DOI: 10.1055/s-2008-1080942
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

An Unusual Case of a Penetrating Skull-base Injury Caused by a Wild Deer's Antler

Hirschgeweihdurchspießung der Frontobasis – FallberichtR. Hebecker 1 , St. Sola 1 , J. H. Lenz 2 , T. Just 3 , J. Piek 1
  • 1Department of Neurosurgery, University of Rostock, Rostock, Germany
  • 2Clinic for Cranio-, Maxillofacial and Plastic Surgery, University of Rostock, Rostock, Germany
  • 3Clinic for Otorhinolaryngology, Head and Neck Surgery „Otto Körner”, Rostock, Germany
Further Information

Publication History

Publication Date:
05 February 2009 (online)

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Abstract

Injuries relevant to neurosurgeons in central Europe are rarely caused by wild animal attacks, whereas dog bites in urban areas and farm-related attacks from cattle and horses are well-known to cause sometimes fatal head injuries. The authors describe the first case of a perforating frontobasal injury caused by a wild deer's antler. Associated lesions involved the endonasal area and the left orbit. A multidisciplinary approach was used to address all lesions in a one-stage operation resulting in a full recovery of the patient. Apart from the problem of a possible contamination of the head wound, injuries caused by wild animal attacks should be treated the same way as comparable “regular” cases. Adequate coverage of dural and bone defects with autologous material via a bifrontal intradural approach and meticulous debridement of the intracranial wound usually gives good functional and cosmetic results.

Zusammenfassung

Angriffe wilder Tiere sind in Mitteleuropa selten Ursache neurochirurgisch relevanter Schädel-Hirn-Verletzungen, während Verletzungen durch Haus- und Hoftiere (Hunde, Pferde, Rinder) gelegentlich einmal Ursache auch tödlich verlaufender Traumen sein können. Die Autoren beschreiben erstmals den ungewöhnlichen Fall einer Hirschgeweihdurchspießung als Ursache einer ausgedehnten frontobasalen Verletzung. Begleitverletzungen betrafen insbesondere das zentrale Mittelgesicht und die linke Orbita. Die operative Versorgung erfolgte direkt nach Klinikaufnahme interdisziplinär durch die Fachdisziplinen HNO, MKG und Neurochirurgie mit einem exzellenten klinischen Ergebnis nach 12 Monaten. Prinzipiell sollten derartige Verletzungen nach den gleichen chirurgischen Regeln (hier: Deckung über ein intradurales Vorgehen mittels autologem Material) wie „gewöhnliche” Frontobasisverletzungen vorgenommen werden. Besondere Aufmerksamkeit ist bei ausgedehnten Verletzungen auf ein sorgfältiges Wunddebridement und mögliche Frühkomplikationen (Pneumenzephalus, Meningitis, Hydrozephalus) zu richten.

Key words

head injury - skull base - animal attack - CSF leak - pneumencephalus

Schlüsselwörter

Schädel-Hirn-Trauma - Schädelbasis - Tier - Liquorrhoe - Pneumenzephalus

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Correspondence

Prof. J. Piek

Department of Neurosurgery

University of Rostock

Schillingallee 35

18055 Rostock

Germany

Phone: 0381/494/64 40

Fax: 0381/494/64 39

Email: juergen.piek@med.uni-rostock.de