“Invisible” Route of a Foreign Body into the Brain

A 22-month-old boy was admitted to another hospital with nasal bleeding and was discharged after 5 days observing without symptom. Epilepsy developed 2 weeks later and he was admitted to our department. Electroencephalography showed right frontal subcortical function failure. Head magnetic resonance imaging proved a foreign body that lasted from left sided corner of nasal septum and rhino basis to the right frontal lobe. Acute surgery performed via transnasal endoscopic approach to aspirate the pus and drain the abscess. At the 8th postoperative day nasal liquorrhea developed that was cured by spinal cerebrospinal fluid drainage kept on for 5 days. The boy was asymptomatic and without any neurological deficit at discharge and during the follow-up examinations in the next one year at all. Transnasal endoscopic approach for pituitary pathologies and skull base tumors are routinely used and they heal without any trace or scar tissue in third person's eye/to be noticed by anyone. Here we report a quite rare transnasal brain injury with a brain abscess causing midline shift and a minimal invasive surgery as a choice of treatment instead of right sided frontal craniotomy with abscess drainage through the brain.