Abstract: Accidental orbital-cranial penetration injuries are rare, and this paper reports a case of traumatic orbital-cranial penetration injury in a senior citizen. The patient was 80 years old female, and the bicycle brake handle penetrated into the skull through the left orbit after a fall. A preoperative cranial CT scan showed that the foreign body penetrated into the frontal base. A craniotomy was performed through a coronal incision to remove the foreign body and repair the skull base defect, followed by surgical removal of the ruptured left eye. The postoperative recovery was smooth, with no complications of infection or cerebrospinal fluid leakage, and a good outcome was obtained. The issues related to this case are discussed in the context of the literature. Keywords: craniocerebral trauma; orbital-cranial penetration injury; foreign body With the presence of the protection of the skull cap bone, adult craniocerebral penetration injury is not common in normal times. In contrast, accidental craniocerebral penetrating injuries occur in the temporal and orbital regions, where the bone is relatively weak. A case of orbital-cranial penetrating injury caused by an 80-year-old bicycle handle was admitted to our hospital and reported as follows. Patient Female, 80 years old, fell down the stairs and hit her face on a bicycle on the night of April 10, 2005, and the broken end of the brake handle pierced into the skull through the left eye. 1h after the injury, the patient was brought to our hospital emergency room. On physical examination, the Glasgow Coma Scale (GCS) was 15, and a black hard plastic foreign body with a diameter of about 2.5 cm was stabbed into the orbit through the left eye, with local active hemorrhage, and the rest of the neurological examination showed no abnormality. The cranial CT scan showed a high-density foreign body pierced into the intracranial end of the left orbit through the medial wall of the left eye located at the midline of the frontal base, and a small amount of high-density contusion hemorrhage was seen around it. A diagnosis of left orbital-cranial penetrating injury was made, and surgery was performed immediately under general anesthesia. A coronal flap incision was taken and the left frontal bone flap was opened. After the dura was cut, the dura was explored along the frontal base to the intracranial end of the foreign body, and after confirming that there was no obvious vascular structure adhesion, the brain tissue at the base of the frontal lobe was protected, and the foreign body of about 10 cm in length was slowly extracted from outside the body under the premise of looking directly at the intracranial end of the foreign body, and the local orbit-cranial communication was repeatedly rinsed with hydrogen peroxide and saline containing gentamicin, and then autologous bone pieces were taken to close the sieve plate bone defect, and then The dural defect was repaired with a small piece of autologous osteochondral bone glued together with otocerebral glue. The frontal lobe base was cleared of contused tissue, the dura was intermittently sutured, the frontal bone flap was restored, and the scalp was sutured in layers. The ophthalmologist then performed an ocular debridement, and because the left eyeball had ruptured, the left eyeball was then removed and the fractured wound below the left eyelid was sutured. The patient recovered smoothly after surgery without secondary intracranial or ocular infections. The postoperative CT scan of the head was reviewed and there was no secondary intracranial hemorrhage, and the patient was discharged 10 days later. At 1-year postoperative follow-up, the patient basically took care of himself and had no change in visual acuity in the right eye. Discussion Cranial penetrating injuries are relatively rare, accounting for about 0.4% of craniocerebral trauma, and are mostly seen in wartime. Craniocerebral foreign body injuries are usually seen in violent injuries or accidental cold injuries, and orbital-cranial penetrating injuries are the most common, which can be caused by metallic or non-metallic foreign bodies. The early management of cranial penetrating injuries focuses on removal of the foreign body, control of fatal intracranial hemorrhage and intracranial hypertension, while the subsequent focus is on the prevention and treatment of secondary injuries and intracranial infections, which can be fatal if not properly managed. In this case, the foreign body penetrated the orbital tissues after the fall injury and then penetrated the medial bone of the left supraorbital wall to enter the skull. Since the foreign body entering the skull had smooth ends and only penetrated the sieve plate to the medial side of the frontal lobe floor, it did not injure the important blood vessels at the skull base and the anterior cerebral artery, and only caused local cerebral contusion at the frontal lobe floor, so the patient did not have obvious neurological dysfunction after the injury, and did not cause fatal intracranial hemorrhage. In the case of penetrating injuries with foreign body piercing into the skull, the foreign body should not be blindly extracted until it is clear whether the intracranial end of the foreign body injures important vascular tissues, so as to avoid serious consequences of secondary intracranial hemorrhage. In this case, after craniotomy to expose the intracranial end of the foreign body and confirm that no important blood vessels and tissues were injured, the foreign body was then removed extracranially, eliminating the risk of secondary damage that might be caused by blind removal. In this case, the open skull base injury, after removing the foreign body and thorough debridement, in order to avoid postoperative CSF leakage and secondary infection, autologous cranial bone and periosteum were used to repair the bone and dural defect at the base of the anterior skull fossa, and no intracranial infection and cerebrospinal fluid leakage complications occurred after surgery. At the same time, because the injured side of the eye had been penetrated and injured, the contents of the eye had spilled out, and the left eye was removed immediately after the craniotomy, and no secondary damage occurred in the right eye after the operation. Except for the removal of the left eye, no other neurological deficits remained in this patient after surgery, and a good treatment result was obtained.