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Persistent Intracranial Hypertension in a Cranial Vault Remodeling Patient With Open Skull Fractures From Horse Kick

Matthew E Braza1, John A Girotto2

  • 13591Spectrum Health/Michigan State University College of Human Medicine Integrated Plastic Surgery Residency, Grand Rapids, MI, USA.

The Cleft Palate-Craniofacial Journal : Official Publication of the American Cleft Palate-Craniofacial Association
|September 14, 2020
PubMed

Insights

Severe traumatic brain injury in a child with prior craniosynostosis surgery required intensive management for intracranial hypertension. Prompt multi-team care and helmet use are crucial for recovery.

Area of Science:

  • Pediatric Neurosurgery
  • Traumatic Brain Injury Management
  • Craniofacial Surgery

Background:

  • A 4-year-old female with a history of cranial vault remodeling for bilateral coronal craniosynostosis experienced a severe traumatic brain injury.
  • The injury involved open skull fractures resulting from a horse kick, presenting a unique clinical challenge.

Observation:

  • The patient developed persistently elevated intracranial pressure (ICP) post-injury.
  • Management included neurosurgical decompressions, maximal medical therapy, and various ICP monitoring devices, with limited initial success.

Findings:

  • Despite initial complications, the patient's intracranial pressure eventually improved.
  • She achieved a full neurological recovery, indicating resilience and effective, albeit delayed, treatment.

Implications:

  • Horse kick injuries can cause severe traumatic brain injuries with significant morbidity.
  • Elevated intracranial pressure in patients with prior cranial vault remodeling warrants careful consideration of potential etiologies.
  • A multidisciplinary team approach and consistent helmet utilization are vital for managing craniosynostosis patients, especially after traumatic brain injury.

Keywords:
cranial vault remodelingcraniosynostosishorse kickintracranial hypertensiontraumatic brain injury

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