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In March 2016, an 18-year-old left-handed male presented to our emergency department with a metal pipe penetrating intracranially through his right orbit (figure 1). The patient had been making an improvised firearm at home, when it backfired and dislodged the cylindrical barrel into his right eye socket. The patient was localizing only with the right upper extremity on arrival but did not follow commands. A CT scan demonstrated that 13.3 cm of the 23 cm metallic pipe extended through his right orbit though his anterior cranial fossa, into the middle cranial fossa (figure 2).
What would you do?
Removal of metal pipe followed by decompressive craniectomy.
Decompressive craniectomy followed by removal of the metal pipe.
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