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

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.