Fatal injury of a skier during school training - case report.

The authors present the case of a fatal accident of a 16-year-old skier who crashed into a tree during a downhill skiing lesson at school. Although the skier was wearing a protective helmet at the time of the accident and his condition did not appear to be too serious immediately after the accident, he later died in hospital as a result of a craniocerebral injury with cerebral contusion and intracranial haemorrhage. His life could not be saved even by immediate neurosurgery, during which fragments of the broken protective helmet were removed from his cranial cavity. By analysing the international literature, the authors identify head and brain injuries as the most common immediate cause of death in downhill skiing and provide insights into the possibilities of preventing these injuries by simple technical means on the part of ski area operators. These means are in particular protective covers for lift columns and protective nets placed in front of fixed, non-movable obstacles on the track.

Particular Surgical Technique for Transorbital-Penetrating Craniocerebral Injury Inflicted by a Screwdriver: Technical Case Report.

Surgical techniques for non-missile penetrating brain injuries (PBI) are challenging because they require good preoperative planning. Generally, extraction is performed ipsilaterally at the entry site. In certain cases, the extraction can be performed contralaterally through the inner end of the foreign body; however, this requires special consideration. We present a case report of a patient who had a stab wound on the head via a screwdriver and underwent surgery, during which extraction was performed contralaterally through the inner end of the screwdriver without inducing any neurological deficit. Careful preoperative planning and surgical technique modification are required to minimize morbidity and mortality in patients with PBIs.

[Metallic foreign bodies of brain ventricles]. / Metallicheskie inorodnye tela zheludochkov golovnogo mozga.

Head injuries are often associated with intracranial foreign bodies that require decision making on the need for certain surgical treatment. Intraventricular foreign bodies are rare, so the question of surgical tactics is still open. OBJECTIVE: To summarize the experience of treating the wounded with intraventricular foreign bodies. MATERIAL AND METHODS: Treatment outcomes in victims with foreign bodies in lateral ventricles are presented. Searching in the e-Library, PubMed, Google Scholar databases included the following keywords: «penetrating wounds¼, «foreign bodies¼, «cerebral ventricles¼, «gunshot injury¼, «ventricular foreign bodies¼. We analyzed data on the treatment of victims with intraventricular foreign bodies. RESULTS: Three victims underwent surgery, and foreign bodies were removed from the occipital horn of the lateral ventricle, third ventricle and temporal horn of the lateral ventricle. Conservative approach was preferred in 1 case. Follow-up ranged from 1 month to 7 years, GOS score - 3-4 points. Disability was due to severe injury and not associated with surgical treatment per se. We found 16 publications matching the searching criteria. Treatment methods varied from standard surgical approaches to stereotactic management. The indication for removal of foreign bodies was their migration through the ventricular system and occlusive hydrocephalus. None patient had neurological aggravation. CONCLUSION: Intraventricular foreign bodies are rare and present certain difficulties in choosing the method and timing of treatment. Indications for their removal are migration, occlusive hydrocephalus and infectious complications. The method of removal is determined depending on location, magnetic properties, nature of injury, surgical preferences and other factors.

Implementación de telerradiología en neurotrauma en áreas de difícil acceso-revisión sistemática / Implementation of teleradiology in neurotrauma in areas of difficult access - systematic review

ABSTRACT: Introduction: According to the world health organization, injuries represent more than 20% of health problems in the world. Head trauma and the absence of neurosurgery and radiology services in less populated areas make it difficult to assess and manage patients with brain injury. Objective: To describe the clinical findings and benefits derived from the implementation of teleradiology in neurotrauma in areas of difficult geographic access. Materials and methods: A systematic search was carried out in Pubmed, Scopus, Ebsco host, Sciencedirect, and Embase, with the thesauri "Teleradiology" and "Craniocerebral Trauma". Results: The decision to intervene in a patient with brain trauma and the period of time until surgery are essential for the clinical outcome. Those centers that use teleradiology require transfers to specialized hospitals, for which portable technological devices contribute to the response time of neurosurgery care. Conclusion: Teleradiology has a positive impact on patients with traumatic brain injury in geographical areas of difficult access, facilitating communication with specialists; providing timely care and optimizing transfers to high complexity centers.

RESUMEN: Introducción: Según la organización mundial de la saludlos traumatismos representan más del 20% de los pro-blemas en salud en el mundo. El trauma craneoencefálico y la ausencia de servicios de neurocirugía y radiología en zonas menos pobladas dificultan la valoración y manejo de pacientes con lesión cerebral. Objetivo: Describir los hallazgos clínicos y beneficios derivados de la implementación de la telerradiología en neurotrauma en áreas de difícil acceso geográfico. Materiales y métodos: Se realizó una búsqueda sistemática en Pubmed, Scopus, Ebsco host, Sciencedirect, y Embase, con los tesauros "Teleradiology" y "Craniocerebral Trauma". Resultados: La decisi-ón de intervenir a un paciente con traumatismo cerebral y el periodo de tiempo hasta la cirugía son fundamentales para el desenlace clínico. Aquellos centros que usan la telerradiología, precisan los traslados a los hospitales espe-cializados, por lo cual los dispositivos tecnológicos portátiles contribuyen en el tiempo de respuesta de la atención en neurocirugía. Conclusión: La telerradiología impacta positivamente en pacientes con trauma craneoencefálico en zonas geográficas de difícil acceso, facilitando la comunicación con especialistas; brindando atención oportuna y optimizando los traslados a centros de alta complejidad. (AU)

Management of War-Related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.

INTRODUCTION: France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management, and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital. METHODS: From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included. RESULTS: We analyzed 48 records. Mean age was 21.9 years (1-46 years) with a 37:11 (male:female) sex ratio and a majority Afghan population (n = 41). Civilians represented 64.6% (n = 31) of casualties. On the battlefield, mean Glasgow Coma Scale score was 9.4 [3-15]. On arrival at the KaIA field hospital, 20 of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (n = 11), debridement craniectomy (n = 19), and craniotomy (n = 12). A total of 32.4% wounded died at the point of injury, 8.4% at the emergency department, and 16.9% after surgery. CONCLUSIONS: War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play.

Clinical Presentation and Outcome of Impalement Craniocerebral Injuries - A CASE SERIES.

Non-missile, low-velocity penetrating craniocerebral injuries are uncommon among civilians and unlike missile injuries, are associated with localized brain injury and subsequent good outcome if managed appropriately. Penetrating injuries to the brain caused by a retained, relatively blunt or sharp object that perforate the brain along its longitudinal axis producing a wound track corresponding to its length of penetration, are called impalement injuries. Most of the impalement craniocerebral injuries are accidental and varying objects have been reported. We report our experience with the management of seven cases of impalement craniocerebral injuries. Five of the patients were adult male while two female children were involved. One case was from assault, others resulted from accidental injury. Left side of the cranium was more commonly involved. The impaled objects in this study included a lead pencil, a screw driver, a branch of a tree, and other metallic objects. Most of the patients had craniectomy and water tight dura repair during remover of the impaled object. All patients made good recovery following surgical intervention. Management principles entail early recognition, deliberate and careful debridement, and judicious antibiotic therapy. The surgical approach to these injuries varies, depending on the route of entry.

Reconstrução de calota craniana com prótese customizada de PMMA após craniectomias descompressivas / Skull reconstruction with PMMA customized prostheses after decompressive craniectomies

Introdução: A craniectomia descompressiva é uma cirurgia indicada no tratamento da hipertensão intracraniana em situações graves de traumas cranioencefálicos. Esta cirurgia confere uma aparência bizarra ao paciente, como se "parte da cabeça" houvesse sido retirada. Após a regressão do edema cerebral e quando o paciente reunir boas condições clínicas, a reconstrução craniana está indicada. A reconstrução da calota craniana poderá ser realizada com osso autólogo ou com materiais aloplásticos. Este estudo objetiva apresentar a experiência do autor com reconstruções de calota craniana utilizando próteses customizadas de PMMA. Métodos: Foram selecionados 14 pacientes submetidos à craniectomia descompressiva que, após serem liberados clinicamente pela Neurocirurgia, realizaram a reconstrução da calota craniana com próteses de PMMA customizadas por prototipagem entre os anos de 2014 e 2015 e com, no mínimo, 6 meses de pós-operatório. Sinais e sintomas de síndrome do Trefinado, tomografia computadorizada e aparência estética dos pacientes foram analisadas no pré e no 6º mês pós-operatório. Resultados: Todos os pacientes apresentaram melhora sintomatológica, melhora estética e expansão cerebral após a cirurgia. Conclusão: A reconstrução da calota craniana com prótese customizada de PMMA promoveu a melhora dos sinais e sintomas e da aparência estética de todos os 14 pacientes operados. A utilização de protótipos para customizar próteses cranianas facilitou a técnica operatória e possibilitou a recuperação de um contorno craniano muito próximo da normalidade.

Introduction: Decompressive craniectomy is indicated for the treatment of intracranial hypertension in cases of serious traumatic brain injury. This surgery results in a bizarre appearance, as if "part of the head" had been. After regression of cerebral edema and when the patient is in good clinical condition, the reconstruction of the skull is indicated. Reconstruction of the skull can be performed with autologous bone or with alloplastic materials. This study sought to present the experience of the author with skull reconstructions using custom PMMA prostheses. Methods: In between 2014 and 2015, fourteen patients with previous (longer than 6 months) decompressive craniectomies were selected after Neurosurgery medical clearance and underwent skull reconstruction with customized PMMA prototyped prostheses. Signs and symptoms of syndrome of the trephined, computed tomography, and aesthetic appearance of the patients were analyzed preoperatively and at 6 months after reconstruction. Results: All patients presented with improved symptomatology, aesthetic improvement and expansion of the brain after surgery. Conclusion: Reconstruction of the skull with customized prototyped PMMA prostheses improved the signs and symptoms and the aesthetic appearance in all 14 patients of this series. The use of prototypes to customize cranial prostheses facilitates the operative technique and enables patients to develop a nearly normal cranial contour.

Classification and management of mild head trauma.

Mild head trauma had been defined in patients with direct impact or deceleration effect admitted with a Glasgow Coma Scale score of 13-15. It is one of the most frequent causes of morbidity in emergency medicine. Although common, several controversies persist about its clinical management. In this paper, we describe the Brazilian guidelines for mild head trauma, based on a critical review of the relevant literature.

Craneoplastía con implante de polieteretercetona diseñado por computadora / Cranial reconstruction using computer designed polieteretercetone implant

Introducción: Existen diferentes materiales para realizar una craneoplastía, siendo el objetivo principal la protección cerebral y el resultado cosmético. Caso clínico: Varón de 29 años que 1 mes antes de ingreso tuvo un trauma encéfalo craneano grave, siendo sometido a hemicraniectomía descompresiva de urgencia. Neurológicamente el paciente se encuentra en coma vigil, traqueostomía, y con un gran defecto óseo de hemicráneo izquierdo. Dos meses después es sometido a una craneoplastía con implante de polieteretercetona diseñado por computadora, fijado con miniplacas, con evolución postoperatoria sin complicaciones. Conclusión: La craneoplastía con implante PEEK diseñado por computadora, es segura, brinda gran adaptabilidad, biocompatibilidad y menor tiempo quirúrgico.

Background: Craneoplasty has 2 purposes; protection of the brain and a satisfying cosmetic result. There are different alloplast grafts to cranial reconstruction. Clinical case: A decompressive craniectomy was performed in a 29 years old man who had a severe brain trauma one month before admission. Clinically he is in coma, with a left large skull defect. After two months the patient is underwent to cranial reconstruction using computer designed polyetheretherketone implant, without complications related to surgery until now. Conclusion: Craneoplasty using computer designed PEEK implant is safe, offers great adaptability and biocompatibility, and minor surgical time.

Clinical analysis of severe craniocerebral injuries complicated by upper cervical vertebral injuries / 中华创伤杂志

Objective To study clinical features of severe craniocerebral injuries complicated by upper cervical vertebral injuries so as to have a deeper understanding and higher vigilantness. Methods Twenty-nine cases of severe craniocerebral injuries complicated by upper cervical vertebral injuries were clinically analyzed. Results Injury causes included traffic accident in 26 cases, fall in one, rolling down in one and mine collapse in one. Treatment results showed that 16 cases survived and 13 died. As for Glasgow Outcome Scale (GOS) score, two cases were ranked at grade Ⅴ, seven at grade Ⅳ, six at grade Ⅲ, one at grade Ⅱ and 13 at grade Ⅰ. Conclusions The severe craniocerebral injuries complicated by upper cervical vertebral injuries are critical and complex mainly because the severe craniocerebral injuries can be paid more attention and diagnosed and treated early while the upper cervical vertebral injuries are easy to be neglected, as gives rise to missed injuries, lack of timely management and high mortality. Therefore, various severe complications are liable for deaths.