RESUMO
Cranial epidural hematoma is a serious event requiring immediate intervention. This can be due to sudden traction tearing the vessels between the dura and the skull. During posterior fossa surgery, brain collapse may emerge due to the sudden reduction of prolonged elevated intracranial pressure; it could cause dura-skull detachment to create epidural hematoma even far from the surgical site. Hence, we should be aware of this complication when approaching posterior fossa tumors as it frequently leads to severe neurologic impairment or death. Here, we report a 12-year old previously healthy child who was admitted with a 4-month history of severe headache, vomiting, and right eye blindness due to increased intracranial pressure. A brain Computed Tomography (CT) scan showed obstructive hydrocephalus, and contrast-enhanced Magnetic Resonance Imaging (MRI) confirmed intraventricular posterior fossa tumor. After tumor resection, the patient developed an epidural hematoma far from the surgery site. Removal of the hematoma exposed lacerations of superior sagittal sinus due to dural detachment. Failure to control intracranial pressure resulted in a fatal outcome.
RESUMO
Introducción: Los traumatismos craneoencefálicos penetrantes son cada vez más frecuentes en la sociedad actual, por lo que el neurocirujano debe estar preparado para atenderlas, siguiendo las guías y recomendaciones para su manejo. Caso: Paciente masculino joven, quien recibió puñalada en el rostro, llegó a la sala de emergencia desorientado y hemiparético. Se comprobó la presencia de arma blanca intracraneal y luego de los exámenes de imagen se procedió en sala de operaciones a retirar el arma retenida, luego de hemostasia y cierre de fístula. Luego de la intervención quirúrgica, fue atendido en la Unidad de Cuidados Intensivos. El control tomográfico posoperatorio no evidenció sangrado. Hubo reversióncompleta de la hemiparesia, sin signos de fistula ni infección. El paciente tuvo una buena evolución hasta su egreso, 12 días más tarde. Discusión: Las imágenes tomográficas y de angiotomografía son de gran ayuda para el neurocirujano, quien precisa de esa información para prevenir potenciales complicaciones intraoperatorias y secuelas neurológicas en el tratamiento quirúrgico de pacientes que han sufrido un trauma craneoencefálico penetrante.
Introduction: Penetrating head injuries are becoming more and more frequent in nowadays socity, therefore, the neurosurgeon should be prepared to deal with. We must stick at rigid surgical protocols. Case: A young male patient stabbed on his face was admitted in the emergency unit of our hospital. He was disoriented and hemiparetic with a knife inside the skull shown by image examns. Patient was sent to the operating room where the neurosurgeon proceeded to remove the knife, under controlled conditions and hemostasis. A brain fistula was closed and the patient was sent to the Intensive Care Unit in the postoperative period. Tomographic control showed no bleeding. Eventually, he was discharged in good condition after 12 days with complete reversal of hemiparesis, without infection or fistula. Discusion: Tomographic imaging and angiography are useful tools for the neurosurgeon, who needs key information to prevent surgical complications and neurologic sequelae when dealing with patients who suffered penetrating head trauma.
