Explore the cutting-edge approach to emergency neurosurgery with our deep dive into the single-staged management of complex frontal penetrating brain injuries and depressed skull fractures.
– by James
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How I do it: single-staged emergency neurosurgical management of frontal penetrating craniocerebral injury with depressed skull fracture.
Beucler et al., Acta Neurochir (Wien) 2024
<!– DOI: 10.1007/s00701-024-05941-2 //–>
https://doi.org/10.1007/s00701-024-05941-2
Military neurosurgeons have shared their protocol for managing penetrating craniocerebral injuries with depressed skull fractures, which are rare but critical emergencies often resulting from traffic accidents or civilian violence. The procedure involves:
- Positioning the patient supine with the head secured by a Mayfield clamp.
- Debriding the frontal wound.
- Using a coronal approach through Merkel’s dissection plane to preserve a pericranial flap.
- Performing a craniotomy around the depressed fracture.
- Employing neuronavigation to assess and manage the frontal sinus.
- Debriding and repairing the brain and dura mater.
- Conducting cranioplasty with either native bone or a titanium plate, depending on the bone’s condition.
Significance: This method streamlines the treatment of frontal penetrating craniocerebral injuries, making it a reproducible technique for neurosurgeons. The approach prioritizes wound closure and uses modern tools like neuronavigation for precision, potentially improving patient outcomes in these emergency situations.