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Severe Pediatric Open Skull Fracture With Exposed Brain Matter: A Case Report
Sophia Mirkin1, Michael Wu1, Jessica Colon1
1Osteopathic Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.
Insights
A severe pediatric head injury case highlights how an open skull fracture may act as a natural decompression, potentially aiding in managing traumatic brain injury (TBI) and intracranial pressure.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Emergency Medicine
Background:
- Pediatric head trauma frequently leads to significant morbidity and mortality.
- Traumatic brain injury (TBI) results from external forces causing brain dysfunction or pathology.
- Intracranial edema and herniation are common TBI complications in children, often managed with decompressive craniectomy.
Observation:
- A 13-year-old male sustained severe head trauma from an unhelmeted all-terrain vehicle (ATV) accident, resulting in loss of consciousness.
- The patient presented with extensive open skull fractures from the frontal to occipital lobes, exposing the brain.
- CT scans revealed displaced fractures across multiple cranial bones, particularly the left temporal bone.
Findings:
- A bilateral hemicraniectomy was performed to address diffuse cerebral edema.
- A ventriculostomy was placed for intracranial pressure (ICP) monitoring and management.
- The open skull fracture with brain exposure may have provided a natural decompressive effect, enabling life-saving interventions.
Implications:
- This case suggests an open skull fracture might offer a unique, albeit severe, form of decompression in pediatric TBI.
- Further research is necessary to elucidate the precise role of open fractures in mitigating elevated ICP and their impact on TBI outcomes.
- Understanding this phenomenon could inform future management strategies for severe pediatric head injuries.
Abstract:
Head trauma in the pediatric population carries a high rate of morbidity and mortality. The major causes of head trauma are related to falls, recreational activities, motor vehicle accidents, and gunshot wounds. Traumatic brain injury (TBI) can occur after severe head trauma and is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Intracranial edema and herniation are common consequences of a TBI in pediatric patients and are commonly relieved via decompressive craniectomy. This case study describes a 13-year-old male presenting to the trauma center after an unhelmeted all-terrain vehicle (ATV) accident with a positive head strike and loss of consciousness. The evaluation revealed extensive skull fractures extending from the frontal to the occipital lobe with brain exposure. Computed tomography (CT) scan of the head demonstrated extensive, open skull fractures with significant displacement of the exposed brain, extensive bilateral parietal and frontal bone fractures, and bilateral temporal bone displaced fractures more extensive on the left. A bilateral hemicraniectomy was performed due to diffuse cerebral edema and a left frontal ventriculostomy was placed to monitor and manage intracranial pressure (ICP). It is believed that the unique presentation of an open skull fracture with an exposed brain acted as a decompressive method allowing for extreme lifesaving measures to be performed to save the patient. Further exploration is needed to truly understand the effects of the unique injury presentation and the role of an open fracture in the delay of increased ICP.
