AlAnsari Ghada A, AlOlyani Amira, Al-Umran Shaymaa, AlDhamen Anwar
Department of Neurosurgery, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.
Department of Neurosurgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
AME Case Rep. 2025 Jul 11;9:92. doi: 10.21037/acr-2025-85. eCollection 2025.
Traumatic brain injuries (TBIs) are significant causes of morbidity and mortality worldwide. A compound depressed skull fracture (DSF) occurs when a laceration over the fracture exposes the internal cranial cavity to the external environment. DSFs are considered surgical emergencies that require prompt intervention to reduce morbidity and mortality. Currently, the literature lacks comprehensive information regarding the risks of intracranial infection and seizures, surgical indications, and the impact of surgical management on the functional and neurological outcomes of penetrating craniocerebral injuries (PCCIs). Our case report aims to enhance the existing literature by providing an overview of the management of frontal bone and frontal sinus fractures. We will emphasize key aspects such as the timing of surgery (early delayed), the risks of infection and seizures, and the selection of prophylactic antibiotics. We present a case of PCCI with DSF that resulted in a favorable functional outcome.
We present a 21-year-old male who was involved in an MVA with an unknown mechanism and was brought by ambulance to our emergency department at Dammam Medical Complex. Initially, the patient was vitally stable, conscious, alert, and oriented. He had multiple scalp lacerations, including a mid-forehead open wound laceration with bone fragments and some brain tissue protruding out of the lacerated wound defect. After clinical deterioration, the patient underwent an urgent surgical exploration and elevation of skull fracture along with primary skull reconstruction. The mid-forehead wound defect was repaired in collaboration with the plastic surgery team.
Although a depressed frontal skull fracture involving both the outer and inner tables of the frontal sinus needs to be addressed on a case-by-case basis, cranialization of the inner table is preferred. Titanium mesh is a satisfactory alternative in case of inapplicable use of the patient's own bone fragments and chips. Collaborating with the plastic surgery team when dealing with complex mid-forehead wounds is also advisable to ensure optimal cosmetic outcomes. It is advisable to use anti-seizure medications (ASMs) prophylactically to prevent early, but not late, post-traumatic seizures (PTSs). A short course of broad-spectrum antibiotics is recommended in cases of open (compound) depressed fractures.
创伤性脑损伤（TBI）是全球发病和死亡的重要原因。当骨折处的撕裂伤使颅内腔与外部环境相通时，就会发生复合性凹陷性颅骨骨折（DSF）。DSF被视为外科急症，需要及时干预以降低发病率和死亡率。目前，关于颅内感染和癫痫发作的风险、手术指征以及手术治疗对穿透性颅脑损伤（PCCI）的功能和神经学结局的影响，文献中缺乏全面的信息。我们的病例报告旨在通过概述额骨和额窦骨折的治疗方法来丰富现有文献。我们将强调手术时机（早期或延迟）、感染和癫痫发作的风险以及预防性抗生素的选择等关键方面。我们报告一例伴有DSF的PCCI病例，其功能结局良好。
我们报告一名21岁男性，因一起机制不明的机动车事故受伤，由救护车送至达曼医疗中心急诊科。最初，患者生命体征稳定，意识清醒、警觉且定向力正常。他有多处头皮裂伤，包括前额中部开放性伤口裂伤，伴有骨碎片和一些脑组织从裂伤伤口缺损处突出。临床病情恶化后，患者接受了紧急手术探查、颅骨骨折复位及一期颅骨重建。前额中部伤口缺损由整形手术团队协同修复。
虽然涉及额窦内外板的凹陷性额骨骨折需要根据具体情况处理，但内板颅骨化是首选方法。在无法使用患者自身的骨碎片和碎骨片时，钛网是一种令人满意的替代方法。处理复杂的前额中部伤口时，与整形手术团队合作也有助于确保最佳的美容效果。预防性使用抗癫痫药物（ASM）以预防早期而非晚期创伤后癫痫发作（PTS）是可取之举。对于开放性（复合性）凹陷性骨折，建议使用短疗程广谱抗生素。
