Yang Chao-hua, Li Qiang, Li Guo-ping, You Chao
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu 610041, PR China.
Pediatr Neurosurg. 2009;45(5):402-6. doi: 10.1159/000260912. Epub 2009 Nov 26.
We report a special type of skull fracture in children - internal open brain injury (IOBI). We summarize its clinical characteristics and propose a treatment strategy based on our experience.
Eight patients between 2 and 5 years old were identified to have IOBI. Preoperative computed tomography (CT) scanning was performed in each case and magnetic resonance imaging was conducted when available. All patients were treated surgically. The clinical data were retrospectively analyzed and each patient underwent follow-up CT scanning.
IOBI has no special clinical manifestations other than scalp swelling, linear skull fracture and local brain contusion. Acute cerebral extrusion outside the calvaria and lacerated dura mater were seen during operation in each patient. Each patient's neurological status generally improved after surgery. No patient developed posttraumatic epilepsy during the 4- to 20-month follow-up period.
IOBI is a type of head trauma in which dura mater is lacerated and the cerebrum is extruded outside the calvaria but the scalp remains intact. Craniotomy with evacuation of devitalized brain tissue and dural repair should be performed.
我们报告一种儿童特殊类型的颅骨骨折——开放性脑内损伤（IOBI）。我们总结其临床特征，并根据我们的经验提出一种治疗策略。
确定8例2至5岁的患者患有IOBI。每例患者术前行计算机断层扫描（CT），如有条件则行磁共振成像。所有患者均接受手术治疗。对临床资料进行回顾性分析，每位患者均接受术后CT复查。
IOBI除头皮肿胀、线性颅骨骨折和局部脑挫伤外无特殊临床表现。术中见每例患者均有急性颅骨外脑挤压和硬脑膜撕裂。术后每位患者的神经状态总体改善。在4至20个月的随访期内，无患者发生创伤后癫痫。
IOBI是一种硬脑膜撕裂、大脑被挤压至颅骨外但头皮保持完整的头部创伤类型。应行开颅手术清除失活脑组织并修补硬脑膜。
