Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine at the University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.
World Neurosurg. 2020 Jun;138:352-354. doi: 10.1016/j.wneu.2020.03.089. Epub 2020 Mar 23.
Fetal trauma during pregnancy can have a significant impact on the developing brain. Fetal trauma can lead to several intracranial pathologies including hypoxic-ischemic injury, skull fractures, and intracranial hemorrhages. Blunt trauma to a fetus resulting in the need for neurosurgical intervention is a rare occurrence and seldom described in the literature.
Here we present the case of a 28-year-old, 36-week pregnant woman who was brought to the hospital by ambulance following a high-speed motor vehicle collision as the restrained driver. On computed tomography of the abdomen, the fetus was found to have a left-sided skull fracture with intracranial hemorrhage. The fetus was emergently delivered by way of caesarean section for lack of fetal movement and indeterminate heart tracings. Postnatally, the neonate had a Glasgow Coma Scale of 7. A postnatal head computed tomography better defined the skull fractures and multiple areas of intracranial hemorrhage. The baby was taken to the operating room for evacuation of the hematomas. At 16 months of age, the baby was well with only mild developmental delay, although a ventriculoperitoneal shunt was needed in a delayed fashion at 3 months of age.
We present a rare situation where emergent caesarean section delivery followed by neonatal craniotomy was necessary. Our case illustrates that good outcomes can be achieved with rapid identification of fetal intracranial injury and intervention.
胎儿在孕期受到创伤会对其发育中的大脑产生重大影响。胎儿创伤可导致多种颅内病变，包括缺氧缺血性损伤、颅骨骨折和颅内出血。导致胎儿需要神经外科干预的钝器伤很少见，也很少在文献中描述。
在此，我们报告了一例 28 岁、36 孕周的孕妇病例，她是作为受限的驾驶员的高速汽车碰撞后被救护车送往医院的。腹部计算机断层扫描发现胎儿左侧颅骨骨折合并颅内出血。由于胎儿活动减少和胎心监护不确定，胎儿紧急通过剖宫产分娩。产后，新生儿格拉斯哥昏迷评分为 7 分。产后头部计算机断层扫描更好地定义了颅骨骨折和多处颅内出血。婴儿被送往手术室清除血肿。在 16 个月大时，婴儿情况良好，仅有轻度发育迟缓，尽管婴儿在 3 个月大时需要延迟放置脑室-腹腔分流管。
我们提出了一种罕见的情况，即需要紧急剖宫产分娩，随后新生儿行开颅术。我们的病例表明，快速识别胎儿颅内损伤并进行干预可以获得良好的结果。
