Our therapeutic strategy for penetrating brain injury

Abstract

Background: Although penetrating brain injury is relatively rare, this should be treated with the appropriate strategy. Showing our recent two cases, we would like to show our therapeutic strategy for this injury.

Case Report: Case No.1; Working in a factory, a 65-year-old man felled down and a steel column penetrated his neck. This steel column was removed and he was transferred to our emergency room. At the arrival, his consciousness was slightly impaired. After the procedure of neck wound, he was getting drowsy. Because brain CT revealed skull base fracture and intracranial hemorrhage in the left frontal lobe, an emergency operation was performed. Case No.2; After drinking alcohol, a 54-year-old man fell down in the garden and a gardening strut penetrated his left orbita. Without removing the gardening strut, he was transferred to our emergency room. At the arrival, he was alert, but, his eye of movement (EOM) was limited to the all directions. Brain CT revealed the edge of the gardening strut was in the intracranial, and a broken tip of skull bone was invaginated into the frontal lobe. Intracranial air and hemorrhage are also found in the frontal lobe and in the ventricles. 3DCTA and 3DCTV revealed no damage of the major vessels. Under the general anesthesia, bicoronal craniotomy was performed and the damaged dura was removed. Then the gardening strut was removed from the outside of clean operation area, and the invaginated tip of skull bone was also removed. The damaged dura was repaired by pericranial flap and the defect of the orbital roof was repaired by a titanium plate. Disorder of EOM disappeared one month after the operation and EOM has not been got worse even one year after the operation.

Discussion & Conclusion: To treat penetrating brain injury, proper operation strategy, proper major vessels evaluation before operation and proper infection control as well as prevention of cerebrospinal rhinorrhea after operation are required. In the operation for penetrating brain injury, using foreign bodies such as a titanium plate to repair the bone defect of the orbita may be controversial, however, this method would be useful for the long term preservation of EOM.