A case of transsphenoidal penetrating skull base injury by gerdening prop

Abstract

The authors report a rare case of transnasal penetration of the skull base from injury by a gardening prop. When a 57-year old female stambled and fell over, the prop was impaled a length of about 5 cm into her left nostril. She had a nose bleed with a severe headache just after it was pulled out. On her admission, she was clearly conscious, and there was cerebrospinal fluid (CSF) leaking from her left nostril. Plane skull X-rays showed a fracture of the sellae turcica, and a computed tomography (CT) scan showed a lot of air in the subarachnoid space and ventricles. We diagnosed CSF rinorrhea and pneumocephalus due to the perforation of the tuberculum sellae. At that time an emergency operation was performed. The operative findings showed that small bone fragments could be seen in the scarred pituitary fossa. The floor of the sellae turcica was repaired with temporal muscle and fascia. She had a good postoperative course. While the clinical signs and symptoms of a patient with a transnasal penetrating injury of the nasal cavity are occasionally not so serious, we should keep in mind the possibility of intracranial complications and perform radiologic evaluations, particularly using CT scan and/or magnetic resonance imaging (MRI).