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Instituto Nacional de Neurología y Neurocirugía

2023, Number 3

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Arch Neurocien 2023; 28 (3)

Bilateral decompressive craniectomy in a patient with head injuries caused by gun projectile: a case report

Riley-Moguel ÁE, Carrera-Salas C, Cortés-Monterrubio RA, Vichi-Ramírez MM, Marín-Márquez G

Language: English
References: 15
Page: 44-48
PDF size: 242.55 Kb.


ABSTRACT

A 38-year-old male patient sustained multiple skull injuries from a small-caliber firearm projectile, which entered through the right eye after being attacked outside his residence. As a result, he suffered head trauma with multifragmented cranial vault fracture causing exposure of the brain mass in the bilateral frontoparietal region, and complete injury to the right eyeball with fractures involving the posterior, lateral, medial walls, roof and floor walls of the orbit. The patient was transferred to the General Hospital of Axapusco, where he presented with a Glasgow Coma Scale score of 8. An initial skull tomography revealed injuries to both hemispheres, bilateral subarachnoid hemorrhage, parasagittal hemorrhagic contusions and cerebral edema, primarily affecting the corpus callosum and cingulum. Consequently, surgical intervention in the form of a hinge-type decompressive craniectomy and debridement was performed within the first 12 hours of trauma. It is worth noting that the patient’s recovery was favorable and without associated complications. In conclusion, early decompressive craniectomy is the preferred surgical treatment when a patient presents with a Glasgow Coma Scale score of less than 9 upon admission, exhibits bihemispheric and posterior fossa injuries along the wound trajectory, undergoes surgery within the first 12 hours following the injury, displays pupillary reactivity, and is older than 35 years of age.


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