Clinical case of surgical and intensive treatment of traumatic brain injury according to the protocol «Management of severe traumatic brain injury»

March 7, 2023
906
Resume

The article presents a clinical case of treatment of a serviceman who was injured as a result of a falling tree in 15 minutes before admission to the hospital. After venous access was established and airway patency was urgently ensured, the patient underwent spiral computed tomography of the brain and chest organs, which visualized a severe open penetrating craniocerebral injury. Urgent surgical treatment was carried out — resection decompression trepanation of the skull on the right (12/14 cm) with removal of epi- and subdural hematoma and removal of a depressed fracture of the bones of the skull, resection decompression trepanation of the skull on the left with removal of subdural hematoma, stabilization of protruding bone fragments above the sinus with a titanium plate. Pathogenic and symptomatic treatment was carried out in the intensive care unit. The patient was discharged to rehabilitation with mild neurological deficit, mild paresis of the left upper extremity. Provision of prompt and competent neurosurgical care, early diagnosis and treatment of brain injury, as well as intensive therapy aimed at preventing secondary ischemic damage to the injured brain, are important for achieving a positive outcome in the treatment of victims with severe brain injuries.

References

  • 1. Cooper D.J., Rosenfeld J.V., Murray L. et al. (2020) Patient outcomes at twelve months after early decompressive craniectomy for diffuse traumatic brain injury in the randomized DECRA clinical trial. J. Neurotrauma, 37(5): 810–816.
  • 2. Chesnut R., Aguilera S., Buki A. et al. (2020) A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med., 46(5): 919–929.
  • 3. Hawryluk G.W.J., Aguilera S., Buki A. et al. (2019) A management algorithm for patients with intracranial pressure monitoring: the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med., 45(12): 1783–1794.
  • 4. Hutchinson P.J., Kolias A.G., Tajsic T. et al. (2019) Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury: consensus statement. Acta Neurochir (Wien), 161(7): 1261–1274.
  • 5. Tsoucalas G., Kousoulis A.A., Mariolis-Sapsakos T., Sgantzos M. (2017) Trepanation practices in asclepieia: systematizing a neurosurgical innovation. World Neurosurg., 103: 501–503.