PMC5629836_01
Brain CT scan at admission, showing contusions at left frontal and temporal lobes and diffuse brain edema area
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F1
The computed tomography (CT) brain scan at admission showed few left frontal and temporal contusions, a small left frontal epidural hematoma and diffuse brain edema [Figure 1] and the decision was for nonsurgical management.
Brain CT scan 24 h post-admission, showing the small left frontal epidural hematoma, slight improvement of brain edema and the tip of the ICP catheter
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F2
The patient was intubated and admitted to the intensive care unit (ICU) after placement of an intraparenchymal catheter for measuring and managing of intracranial pressure (ICP) [Figure 2].
Intraoperative photo of the patient's brain (swollen) immediately after the craniectomy, before dural incision. Despite the wide craniectomy and decompression our impression was that dural opening would cause bilateral encephalocele, so the decision was to perform multiple dural incisions instead
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F3
Furthermore, due to excessive swelling of the underlying brain, we decided to perform dural incisions instead of flap durotomy [Figures 3 and 4].
The craniectomy parts resynthesized: six burr holes were used in total and the bone was cut parallel to the sagittal venus to avoid injury. Care was taken in adequately decompressing the temporal and parietal lobes
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F4
Furthermore, due to excessive swelling of the underlying brain, we decided to perform dural incisions instead of flap durotomy [Figures 3 and 4].
T1-weighted axial MRI scan + gd enhancement, one month post-injury, showing significant improvement of brain edema and haemorrhagic lesions
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A 1-month post-injury magnetic resonance imaging (MRI) scan also showed significant improvement of the intracranial lesions [Figure 5].