Timing of craniotomy in a patient with multiple trauma including head injury.
A 7-year-old boy suffered blunt multiple injuries to the head, face, chest, and abdomen in a motor vehicle accident. On admission he had impaired consciousness and dyspnea. Radiographic studies revealed facial fracture and pulmonary contusion. Shortly after admission, he fell into shock due to intraabdominal bleeding. Laparotomy revealed spleen rupture. His vital signs remained unstable and bloody drainage from the abdominal cavity continued after surgery. Computed tomography showed traumatic intracerebral hematoma in the right temporal lobe, enlarging and compressing the brainstem. Abdominal reoperation was performed first to control the bleeding and stabilize the hemodynamics, disclosing renal laceration. Then evacuation of the intracerebral hematoma and decompressive craniectomy was performed. Postoperatively, his hemodynamics were stabilized. Clinical course was uneventful and neurological deficits gradually improved. Three months after the trauma, the patient was discharged on foot. This case emphasizes the importance of hemodynamic stability in decisions of neurosurgical indication and timing in patients with multiple trauma including head injury.
Fukai
Junya
J
Department of Neurosurgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. jun-fukai461111@est.hi-ho.ne.jp
Tsujimoto
Toshihide
T
Yoshimura
Ryo
R
Raimura
Masaki
M
Kuwata
Toshikazu
T
Hyotani
Genhachi
G
Yabumoto
Michio
M
Itakura
Toru
T
Kamei
Ichiro
I
D000063:Accidents, Traffic; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001933:Brain Stem / Q000503:physiopathology; D020202:Cerebral Hemorrhage, Traumatic / Q000209:etiology* / Q000601:surgery; D002648:Child; D003399:Craniotomy; D019299:Decompression, Surgical; D005147:Facial Bones / Q000293:injuries; D006439:Hemodynamics; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D007813:Laparotomy; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D012086:Reoperation; D012887:Skull Fractures / Q000209:etiology; D013161:Splenic Rupture / Q000209:etiology / Q000601:surgery; D013702:Temporal Lobe / Q000293:injuries; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000601:surgery