Management Of Craniocerebral Injuries Research Articles

Management of Craniocerebral Injuries in the Neurosurgery Department

The authors describe a retrospective study about 257 cases of cranio-cerebral wounds collected over a period of 7 years (2017 to 2024) in the neurosurgery department of CHU Mohammed IV of Marrakech. The craniocerebral wounds represent 19% of all head injuries. The male is very significant (75%). The average age was 28.6 years. Accidents highway is the major cause (44%) and assaults (35%). The majority of patients were admitted during weekends and summer months. On admission, 34.24% of head injuries were severe (GCS ≤ 8), signs deficits were noted in 17% of cases and autonomic disorders in 21.4%. scaner brain was performed in all patients, it has detected the CPC and the lesions associated with intracranial contusion ranked first with 42.39%. The therapeutic management consisted of medical treatment associated with surgery. (Craniotomy+ recovery plan dural and skin). The postoperative course was excellent in 84% cases while in 16% of complications occurred and dominated by neurological deficits.

From Henry Shrapnel (1761-1842) to today's neurosurgery: how antipersonnel weapons have laid the foundation of clinical and surgical management of head injury fractures and penetrating brain injuries.

Henry Shrapnel invented an antipersonnel weapon capable of defragmenting with the explosion of charge. Modern grenades or improvised explosive devices may be seen as an evolution of Shrapnel's ammunition. Starting by analyzing the ballistics of these weapons, it is possible to understand the historical evolution of the management of skull fractures and penetrating brain injuries (PBIs). A circular crack line with a splinter at the center, depressed in bone, was a characteristic feature of fractures due to Shrapnel's bullet. Three longitudinal fissures, one medial and two lateral, may be present due to tangential blows. Craniectomy and/or fracture reduction were almost always necessary in these cases. The first document describing medical examination and therapeutic strategies for head-injured patients dates back to 1600 bc (the Edwin Smith Papyrus). Several doctors from the past century, such as Puppe, Matson, and Cushing, proposed different theories about skull fractures and the management of craniocerebral injuries, paving the way for diagnosing and treating these injuries. Shrapnel fractures required wider craniotomies and in the past surgeons had to deal with more severe injuries. Based on past military experiences during what could be called the postshrapnel age, guidelines for the management of PBIs were introduced in 2001. In these guidelines various concepts were reviewed, such as the importance of antibiotics and seizure prevention; included as well were prognostic factors such as hypotension, coagulopathy, respiratory distress, and Glasgow Coma Scale score. Furthermore, they highlight how it has not been possible to reach a common viewpoint on surgical management. Nevertheless, in contrast with the past, it is preferable to be less aggressive regarding retained fragments if there is no intracranial mass effect. Although military situations were useful in building basic principles for PBI guidelines, civilian PBIs differ noticeably from military ones. Therefore, there is a need to review modern guidelines in order to apply them in every situation.