2021 年 44 巻 2 号 p. 39-43
An 8–year–old girl accidentally fell, and a pencil in her hand punctured the left temporal side of her skull. Her vital signs were normal at the time of transport to the previous hospital. Head computed tomography (CT) showed that the pencil had perforated from the left temporal side of her head to the left caudate nucleus, with hematoma along the perforating path, ventricular hematoma, traumatic subarachnoid hemorrhage, and subdural hematoma. Vascular evaluation using head CT angiography did not reveal any obvious main trunk vessel occlusion or injury. The patient was intubated and sedated to prevent the pencil from pulling out, and craniotomy was immediately performed to remove the pencil. The area of craniotomy was determined assuming right frontotemporal craniotomy, and the skin incision was made to include the pencil insertion site. The pencil was removed, and external decompression was performed to avoid cerebral edema. Postoperatively, the patient was managed in the pediatric intensive care unit. Prophylactic administration of antimicrobials and anticonvulsants was initiated, and the patient did not develop signs of infection or convulsions. Postoperative follow–up imaging showed no traumatic intracranial aneurysm formation. After reduction of brain swelling, cranioplasty was performed on postoperative day 23. Rehabilitation evaluation showed no obvious sequelae, and the patient was discharged to home on postoperative day 35. Although perforating head injuries in the temporal region are relatively rare, they more likely occur in children with soft skulls than in adults. For the treatment of perforating head trauma, it is important not to perform blind removal until surgical treatment. Preoperative assessment of vascular damage should be performed for decision making regarding the appropriate surgical treatment and postoperative management. Subsequently, it is important to confirm that there is no traumatic cerebral aneurysm formation.