Lan Zhi Gang, Richard Seidu A, Li Jin, Yang Chaohua
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Immunology, Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China.
Int Med Case Rep J. 2018 Mar 9;11:41-45. doi: 10.2147/IMCRJ.S157237. eCollection 2018.
Nonprojectile penetrating skull base injuries as a result of falls have rarely been confronted in normal neurosurgery although a few nonmissile injuries have been reported. These kinds of injuries represent a life-threatening emergency.
We present an unusual case of a 25-year-old male construction worker who suffered an accidental penetrating skull base injury when he fell on a metal rod while he was walking on a 2-meter-high platform. He was clinically stable at presentation. Skull radiograph showed a solid metallic bar, 30 cm long, that penetrated through the right anguli oris eminence and was lodged low in the right occipital bone.
Penetrating injury to the head is considered a form of severe traumatic brain injury. Although case of penetrating head injuries as a result of fall from heights are very rare, we anticipate the construction works on high-rise buildings are at maximum risk. We advise that removal of this kind of foreign bodies be done in the theater and not outside because of risk of involvement of larger vessels leading to fatal hemorrhage. We further suggest that patients with nonprojectile injuries should undergo a preoperative computed tomography-angiography to rule out any vascular injury.
尽管有少数非投射性颅脑损伤的报道，但在普通神经外科手术中，因跌倒导致的非投射性颅底穿透伤很少遇到。这类损伤是危及生命的紧急情况。
我们报告一例不寻常的病例，一名25岁男性建筑工人在两米高的平台上行走时不慎摔倒在一根金属杆上，导致意外的颅底穿透伤。他就诊时临床情况稳定。颅骨X线片显示一根30厘米长的实心金属棒穿透右口角隆起并嵌顿于右枕骨下部。
头部穿透伤被认为是一种严重的创伤性脑损伤形式。尽管高处坠落导致头部穿透伤的病例非常罕见，但我们预计高层建筑施工人员面临的风险最大。我们建议在手术室而不是在室外取出这类异物，因为存在累及较大血管导致致命出血的风险。我们进一步建议，非投射性损伤患者应在术前进行计算机断层血管造影，以排除任何血管损伤。
