PMC9062926_01
The left frontoparietal lacerated and contused wound extending to the frontosphenoidal suture measuring 6 cm in maximum diameter.
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F1
On his initial assessment, the emergency physician found a Glasgow Coma Scale (GCS) score of 3, a left frontoparietal lacerated and contused wound extending to the frontosphenoidal suture [Figure 1], hypotension, and tachycardia.
Preoperative CT scans of the head demonstrating (a) a right parietal fracture with underlying frontoparietal pneumocephalus and (b) bilateral multifragmentary burst fractures of the skull accompanied by the presence of intracerebral foreign bodies exhibiting metal density and causing interhemispheric and subarachnoid hemorrhage.
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F2
Computed tomography (CT) scan of the head and neck showed a right parietal fracture with underlying frontoparietal pneumocephalus [Figure 2].
Following the first surgery, the patient developed signs of infection, and a control CT scan of the head showed (a) evidence of abscess formation and wound dehiscence and (b) obstructive hydrocephalus. (c) Subsequent surgical treatment consisted of an enlargement of the first craniotomy and positioning of a ventriculoperitoneal shunt.
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F3
Despite following standard of care bundles to prevent surgical site infection, the administration of 1 g of topical vancomycin in the subgaleal space, and tight glycemic control, he eventually developed signs of infection 3 days after surgery, and a control CT scan of the head showed evidence of abscess formation and wound dehiscence, accompanied by obstructive hydrocephalus [Figure 3].