Abstract
BACKGROUND: Transorbital penetrating objects traversing the cavernous sinus can cause life-threatening vascular injuries. Here, the authors report a unique case of bilateral transorbital penetrating plastic chopsticks traversing the cavernous sinus, in which a lateral suboccipital approach was used to manage bleeding from the posterior wall of the cavernous sinus. OBSERVATIONS: A 39-year-old man attempted suicide by stabbing plastic chopsticks through his orbits into the intracranial compartment. On admission, he had lost vision and exhibited complete ophthalmoplegia. A CT scan revealed chopsticks penetrating through the superior orbital fissure and cavernous sinus, extending toward the brainstem. Catheter angiography confirmed that the internal carotid arteries were compressed, but no arterial injuries were evident. A lateral suboccipital approach was selected for both sides. After careful extraction along their trajectory from the orbit, homeostasis was achieved by applying a cellulose hemostatic agent to compress the posterior wall of the cavernous sinus. After the surgery, the patient regained some light perception and was discharged without signs of infection or delayed vascular injuries. LESSONS: The safe removal of transorbital penetrating objects that involve the cavernous sinus can be effectively accomplished by a lateral suboccipital approach, which provides a clear surgical field and facilitates accurate homeostasis. https://thejns.org/doi/10.3171/CASE25154.