Management of open craniocerebral injury in a patient with a skull defect: a case report

Abstract Background: Open craniocerebral injury is a bodily injury that is characterized by high mortality and poor prognosis. This type of trauma occurs in patients with skull defects; this is a peculiar accident and is relatively rare. Because of its rarity, the treatments for such injuries are complex and nonstandardized. Case presentation: We present the case of a 66-year-old male with a right frontotemporal skull defect who was hit by a tractor in his head and was accompanied by loss of consciousness for 3 h. Computer tomography (CT) demonstrated a hit on the left frontal area and a multifragmented fracture of the bilateral frontal and orbital bone with partial defects and partial elevation of the fractured bone fragments. A hemorrhagic contusion in the bilateral frontal area directly next to the injury was accompanied by a subdural hematoma at the skull defect site, subarachnoid hemorrhage, or ventricular hemorrhage. Early debridement, hematoma evacuation, and decompressive craniectomy were performed, and the patient achieved good postoperative recovery. Conclusions: In this study, we discussed the clinical presentation and successful management of this unique injury in a patient with a skull defect. Our goal is to demonstrate certain general management principles that can improve patient outcomes.