Successful treatment of severe penetrating cranio-cerebral trauma, associated with brain compression

Authors

  • Andriy Sirko Dnеpropetrovsk State Medical Academy, Dnepropetrovsk; Mechnikov Dnepropetrovsk Regional Clinical Hospital, Dnepropetrovsk, Ukraine https://orcid.org/0000-0001-6536-2035
  • Grigoriy Pilipenko Mechnikov Dnepropetrovsk Regional Clinical Hospital, Dnepropetrovsk, Ukraine

DOI:

https://doi.org/10.25305/unj.60851

Keywords:

severe penetrating cranio-cerebral trauma, nasal liquorrhea, skull base fracture, decompressive craniectomy, intracranial hypertension

Abstract

Introduction. Surgical treatment of severe penetrating cranio-cerebral trauma (SCCT) is a complex problem. Basal liquorrhea (BL) at skull base fractures causes high risk of purulent-septic complications. Conservative BL treatment at scull base fractures with many splinters sometimes ineffective. Along with intracranial hypertensia elimination at decompressive craniectomy (DC) performance and mass-centers removing, during primary operation plastics of scull base defects is needed.

Methods. In two patients with SCCT during one operation DC and mass-centers removing were performed stage-by-stage, plastics of scull base defects, using autotissue on a feeding stalk and haemostatic sponge with fibrin-trombin covering “Takhokomb” were used. For intracranial hypertension control during operation and after it continuous monitoring of intracranial pressure was used.

Results. The use of proposed approach to SCCT treatment allowed to provide control of intracranial pressure after operation and liquorrhea termination, to avoid intracranial purulent-septic complications.

Conclusions. Stage-by-stage DC, mass-centers removing and removal and skull base defects plastics during primary operation — is an effective method of surgical treatment of SCCT, combined with brain compression, scull base fractures and profuse nasal liquorrhea.

References

1. Guidelines for the Surgical Management of Traumatic Brain Injury. Brain Trauma Foundation, American Association of Neurological Surgeons. Neurosurgery. 2006;58(3) suppl.2:46.

2. Konovalov AN, Likhterman L B, Potapov AA. Klinicheskoye rukovodstvo po cherepno-mozgovoy travme [Clinical guidelines for traumatic brain injury]. Editor by Konovalov AN. Mocsow: ANTIDOR; 1998. Russian.

3. Schmidek HH, Roberts DW. Operative neurosurgical techniques. Philadelphia:Saunders; 2006.

4. Greenberg MS. Handbook of neurosurgery. New York; Stuttgart: Thieme; 2006.

5. American Association of Neuroscience Nurses. Care of the patient undergoing intracranial pressure monitoring/external ventricular drainage or lumbar drainage. Glenview (IL): American Association of Neuroscience Nurses; 2011.

6. Whitfield PC, editor. Head injury. A multidisciplinary approach. Cambridge: Univers. Press; 2009.

7. Potapov AA, Likhterman LB, Zelman VL, editors. Dokazatelnaya neyrotravmatologiya [Evidence neurotraumatology]. Moscow: NII neyrokhirurgii im. N.N. Burdenko RAMN; 2003. Russian.

8. Hardt N. Neurocranial injuries in craniofacial, skullbase fractures. In: Hardt N, Kuttenberger J. Craniofacial Trauma. Diagnosis and Management. Philadelphia: Springer; 2010.

Published

2012-09-25

How to Cite

Sirko, A., & Pilipenko, G. (2012). Successful treatment of severe penetrating cranio-cerebral trauma, associated with brain compression. Ukrainian Neurosurgical Journal, (3), 64–68. https://doi.org/10.25305/unj.60851

Issue

Section

Case Report