Minimally invasive keyhole supraorbital craniotomy as treatment option for penetrating foreign body through orbital roof.

Intraorbital foreign body is a rare condition, especially when extending into the intracranial compartment. When facing this scenario in the ER, the neurosurgeon must carefully choose the optimal point of surgical access in order to reduce morbidity. The authors hereby report the case of a 66 year-old male with a penetrating trauma to the orbit reaching the anterior cranial base through the orbital roof and associated with an intracerebral hematoma. The removal of the foreign body was performed by a dual approach: an 'eyebrow' supraorbital keyhole craniotomy and an intra-orbital extra-ocular exploration, with later microsurgical drainage of the hematoma and evisceration of the eye 48 hours later. The patient developed a pseudomeningocele, which was treated with lumbar puncture and compressive dressing. After proper intravenous antibiotic prophylaxis, the patient was discharged 21 days after hospital admission.