Korean J Neurotrauma.  2017 Oct;13(2):141-143. 10.13004/kjnt.2017.13.2.141.

Concurrent Surgery of Craniectomy and Splenectomy as Initial Treatment in Severe Traumatic Head Injury: A Case Report

• Lee HR
• You NK
• Seo SJ
• Choi MS

• KMID: 2394549
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.141

Abstract

It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.

Keyword

Combined operation; One-stage treatment; Severe TBI

MeSH Terms

Adult
Blood Pressure
Brain
Brain Edema
Craniocerebral Trauma*
Emergencies
Emergency Service, Hospital
Fractures, Multiple
Glasgow Coma Scale
Head*
Heart Rate
Hemoperitoneum
Hemorrhage
Humans
Intracranial Pressure
Joints
Methods
Motorcycles
Multiple Trauma
Neurosurgery
Oxygen
Pupil
Rehabilitation
Respiratory Rate
Splenectomy*
Subarachnoid Hemorrhage
Trauma Centers
Ultrasonography
Vital Signs
Oxygen

Figure

• 

  FIGURE 1 (A) Brain computed tomography (CT) and (B) abdominal CT at emergency department. (A) Subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral swelling were observed in brain CT, (B) a small amount of hemoperitoneum was detected in abdominal CT.

• 

  FIGURE 2 Surgical view at operating room. (A) Over view of surgery for simultaneous bicoronal craniectomy and splenectomy, (B) the surgery is undergoing using modified Mayo stand.

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