Abstract
Penetrating traumatic brain injuries (TBI) are frequent neurosurgical emergencies, associated with a high mortality rate and we almost no previous report on a penetrating pickaxe TBI. Herein, we report and discuss the anesthetic challenges encountered in the surgical extraction of a pickaxe from a patient with TBI. We present the case of a 34-year-old man who presented with a penetrating pickaxe TBI at his left temporal region, signs of raised intracranial pressure and normal vital signs. Anesthetic management began within 3 hours of admission and consisted of general anesthesia and rapid sequence intubation. Surgical extraction of a 14 cm long wing of the pickaxe was achieved with good hemostatic control. His postoperative course was marked by complete blindness of the right eye till one year of follow-up. The authors highlight the need of a prompt multidisciplinary management with close perioperative monitoring of haemostatic control and signs of raised intracranial pressure as key factors for a favourable postoperative outcome.
Highlights
IntroductionPenetrating traumatic brain injury (TBI) is defined as a trauma sustained to the brain by an inanimate projectile object that penetrates the skull, and meninges, and injures the brain parenchyma exposing the cranial vault to the external environment [1]
We present the case of a 34-year-old man who presented with a penetrating pickaxe traumatic brain injuries (TBI) at his left temporal region, signs of raised intracranial pressure and normal vital signs
Penetrating traumatic brain injury (TBI) is defined as a trauma sustained to the brain by an inanimate projectile object that penetrates the skull, and meninges, and injures the brain parenchyma exposing the cranial vault to the external environment [1]
Summary
Penetrating traumatic brain injury (TBI) is defined as a trauma sustained to the brain by an inanimate projectile object that penetrates the skull, and meninges, and injures the brain parenchyma exposing the cranial vault to the external environment [1]. Penetrating TBI disproportionately affects young male adults [5] [6] [7]. This makes it an occupational disease and raises considerable concerns for the economic impact of the disabilities that may arise in these productive members of society. We report and discuss the anesthetic challenges encountered in the surgical management of a patient presenting with penetrating pickaxe TBI. This report is the first in Cameroon and perhaps sub-Saharan Africa at large
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