Kasper Ekkehard M, Luedi Markus M, Zinn Pascal O, Rubin Peter A D, Chen Clark
Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Surg Neurol Int. 2010 Dec 25;1:94. doi: 10.4103/2152-7806.74241.
Penetrating brain injuries caused by explosions are survived in extremely rare cases only. However, potential casualties of such cases may be encountered by regular physicians even outside a war zone, e.g., due to an assault or terror blast. There is very limited literature to this end; therefore, we report the successful neurosurgical management of a penetrating head injury due to a pipe bomb explosion.
A 19-year-old man was brought to the ER with a swollen, bleeding right orbit, and a severely injured left hand after having sustained an unwitnessed explosion from a self-made pipe bomb. He presented with a GCS (Glasgow Coma Scale) of 15 at time of admission, work-up revealed an intracranial retained metal fragment measuring 5 × 1 × 0.2 cm lodged retro-orbitally and in the skull base. The patient underwent emergent right temporal craniotomy and temporal lobectomy and simultaneous right enucleation before the petrous bone and sphenoid wing lodged metal fragment was successfully removed.
This case underscores the importance of having a high suspicion for the presence of an intracranial injury and a retained foreign body in the setting of a penetrating head injury. Aggressive and timely workup as well as expeditious surgical management are crucial in these settings and can generate exceptionally good outcomes despite a major trauma.
爆炸导致的穿透性脑损伤仅有极少数情况能够存活。然而，即使在战区之外，普通医生也可能遇到此类潜在的伤亡病例，例如因袭击或恐怖爆炸事件。关于这方面的文献非常有限；因此，我们报告了一例因管状炸弹爆炸导致的穿透性头部损伤的成功神经外科治疗案例。
一名19岁男性在遭受自制管状炸弹爆炸（无人目睹）后，被送往急诊室，其右眼眶肿胀、出血，左手严重受伤。入院时格拉斯哥昏迷量表（GCS）评分为15分，检查发现一枚颅内残留金属碎片，尺寸为5×1×0.2厘米，位于眶后及颅底。患者接受了急诊右侧颞骨开颅术和颞叶切除术，并同时进行了右侧眼球摘除术，随后成功取出了位于岩骨和蝶骨翼的金属碎片。
该病例强调了在穿透性头部损伤情况下，高度怀疑存在颅内损伤和残留异物的重要性。在这些情况下，积极及时的检查以及迅速的手术治疗至关重要，尽管遭受了严重创伤，但仍可产生非常好的治疗效果。
