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Updated: Jun 26, 2026
Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Timing of craniotomy in a patient with multiple trauma including head injury
Junya Fukai1, Toshihide Tsujimoto, Ryo Yoshimura
1Department of Neurosurgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan. jun-fukai461111@est.hi-ho.ne.jp
Insights
A severe motor vehicle accident led to multiple traumatic injuries in a child. Prioritizing hemodynamic stability allowed for successful surgical interventions and recovery, highlighting its importance in managing complex trauma cases.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Neurosurgery
Background:
- Motor vehicle accidents are a leading cause of pediatric trauma.
- Multiple injuries, including abdominal and head trauma, present complex management challenges.
- Hemodynamic instability is a critical factor influencing treatment decisions in polytrauma.
Observation:
- A 7-year-old boy sustained blunt force trauma to the head and abdomen.
- Initial management focused on stabilizing shock from intraabdominal bleeding (spleen rupture, renal laceration).
- A concurrent traumatic intracerebral hematoma required neurosurgical intervention after abdominal reoperation.
Findings:
- Sequential surgical management, prioritizing abdominal hemorrhage control, was crucial.
- Decompressive craniectomy and hematoma evacuation were performed once hemodynamics stabilized.
- The patient demonstrated significant neurological and physical recovery, discharged ambulatory.
Implications:
- Hemodynamic stability is paramount for determining the timing of neurosurgical interventions in polytrauma.
- A multidisciplinary approach is essential for optimizing outcomes in severe pediatric trauma.
- Early recognition and management of intraabdominal bleeding are critical in preventing secondary brain injury.
Abstract:
A 7-year-old boy suffered blunt multiple injuries to the head, face, chest, and abdomen in a motor vehicle accident. On admission he had impaired consciousness and dyspnea. Radiographic studies revealed facial fracture and pulmonary contusion. Shortly after admission, he fell into shock due to intraabdominal bleeding. Laparotomy revealed spleen rupture. His vital signs remained unstable and bloody drainage from the abdominal cavity continued after surgery. Computed tomography showed traumatic intracerebral hematoma in the right temporal lobe, enlarging and compressing the brainstem. Abdominal reoperation was performed first to control the bleeding and stabilize the hemodynamics, disclosing renal laceration. Then evacuation of the intracerebral hematoma and decompressive craniectomy was performed. Postoperatively, his hemodynamics were stabilized. Clinical course was uneventful and neurological deficits gradually improved. Three months after the trauma, the patient was discharged on foot. This case emphasizes the importance of hemodynamic stability in decisions of neurosurgical indication and timing in patients with multiple trauma including head injury.
