Endoscopic Surgery Helps Preserve Vision After Complex Orbital Injury: Dr. Harnarayan Singh
Surgeons at Shalby International Hospital successfully removed a metal fragment near the optic nerve using a specialized endoscopic technique.
In a remarkable medical feat, a multidisciplinary team of specialists has successfully restored hope to an 18-year-old patient from Iraq, saving his vision after a devastating explosion left a metal fragment lodged deep within his eye socket. The patient had already lost nearly 70% of his vision in his right eye due to the initial injury, making the subsequent surgical intervention a high-stakes race against time and anatomical complexity.
The Perilous Challenge: A Fragment Near the Optic Nerve
The injury was exceptionally complex due to the nature of the foreign object. A one-centimetre-long metal shard was found lodged precariously close to the optic nerve. This specific placement presented a nightmare scenario for surgeons; any slight deviation during the removal process could result in permanent total blindness. The intensity of the case was underscored by the fact that several hospitals had previously refused to take on the boy's treatment due to the extreme risks involved.
Before arriving at Shalby International Hospital, the patient had already undergone multiple procedures that failed to resolve the underlying issue. He continued to suffer from persistent pain, which intensified whenever he attempted to move the affected eye.
Choosing the Endoscopic Path Over Craniotomy
When the medical team evaluated the case, they had to decide between traditional surgical methods and more modern, minimally invasive techniques. One option was a craniotomy—a procedure involving the removal of a portion of the skull to access the orbit from above. While effective, this method carried a higher risk of damaging the optic nerve and would have left a visible scar.
Dr. Harnarayan Singh, Director and HOD of Neurosurgery, emphasized the delicacy of the task. "In this case, the biggest challenge was not simply removing the foreign body. It was removing it without causing further damage to an eye that had already suffered a major injury," he stated.
Ultimately, the team opted for an endoscopic endonasal technique. This approach allowed the surgeons to reach the fragment through the nose, providing a safer and more direct route to the inner side of the optic nerve without the need for invasive skull surgery.
Precision in a Limited Workspace
The procedure was far from routine. Endoscopic endonasal surgery for such deep-seated orbital injuries is rare due to the extremely limited working space and the intricate anatomy of the region. Surgeons must maintain absolute precision while maneuvering instruments around critical nerve structures.
Dr. Kunal Nigam, Senior Consultant and HOD of ENT, highlighted the strategic importance of the chosen route: "The fragment was located on the inner side of the optic nerve. Approaching it through the nose gave us a more favourable route. Our priority was to remove the metal while preserving remaining vision."
A Five-Hour Triumph for Neurosurgery
The complex operation lasted approximately five hours. The neurosurgery and skull base surgery team, led by Dr. Singh and Dr. Nigam, meticulously navigated the deep orbital region to extract the centimetre-long metal piece. The successful removal of the fragment marks a significant victory for the medical team and provides a new lease on life for the young patient.
Reflecting on the success, Dr. Harnarayan Singh noted the necessity of meticulous planning: "The eye had already lost a significant amount of vision because of the original injury. So, every step during the surgery had to be carefully planned. The case highlights how difficult orbital injuries can become when a foreign body remains lodged close to the optic nerve."