Lee Hyeong Rae, You Nam Kyu, Seo Sook Jin, Choi Mi Sun
Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
Korean J Neurotrauma. 2017 Oct;13(2):141-143. doi: 10.13004/kjnt.2017.13.2.141. Epub 2017 Oct 31.
It is not a common case for neurosurgery department and the other departments to perform joint operation at the same time. Patients with severe head injury are a condition in which vital signs are unstable due to severe brain swelling and increased intracranial pressure, and emergency surgery is required. A 44-year-old man visited the trauma center with a motorcycle accident. The Glasgow Coma Scale score at the time of emergency department was 3 points, and the pupil was fixed at 6 mm on both sides. His medical history was unknown. His vital signs including blood pressure (BP), heart rate, respiratory rate and oxygen saturation were stable. Associated injuries included multiple fractures of whole body. Brain computed tomography revealed subarachnoid hemorrhage, intraventricular hemorrhage and severe cerebral edema. During the preparation of the craniectomy, abdominal ultrasonography performed because of decreased BP resulted in a large amount of hemoperitoneum. The bi-coronal craniectomy and splenectomy were performed simultaneously for about 4 hours. After fifty days of treatment, he was discharged with Glasgow Outcome Scale-extended 4 points and is undergoing rehabilitation. In severe polytrauma patients, active concurrent surgery is a good method to save their lives.
神经外科与其他科室同时进行联合手术的情况并不常见。重型颅脑损伤患者因严重脑肿胀和颅内压升高导致生命体征不稳定，需要进行急诊手术。一名44岁男性因摩托车事故就诊于创伤中心。急诊科就诊时格拉斯哥昏迷量表评分为3分，双侧瞳孔固定于6mm。其病史不详。他的生命体征包括血压（BP）、心率、呼吸频率和血氧饱和度稳定。合并伤包括全身多处骨折。脑部计算机断层扫描显示蛛网膜下腔出血、脑室内出血和严重脑水肿。在准备开颅手术期间，因血压下降进行腹部超声检查发现大量腹腔积血。同时进行双冠状开颅手术和脾切除术，手术持续约4小时。经过五十天的治疗，他以格拉斯哥预后量表扩展版4分出院，目前正在接受康复治疗。在严重多发伤患者中，积极同时进行手术是挽救生命的良好方法。
