Patient: My third brother was accidentally injured on December 6, 2008 at a construction site in Zhejiang province: a big hole was made in the back of his head by a steel pipe, the meninges were ruptured, the main vein in the brain was broken, the right eyeball was rolled out of the eye socket (surgically removed on the same day), and the whole facial bone was crushed …… The meninges of the back of the head were mended with artificial meninges on the same day, and he is still in Zhejiang province. It’s been more than a month, but the meninges still have no signs of healing, and the first two days there was yellow water …… Is there a way to repair the ruptured meninges at the back of the head? (Because the patient is still being treated at the Rui’an People’s Hospital, he wants to be transferred back to Sichuan, so all the case information cannot be uploaded at this time). Doctor: Actually the core problem of the patient is already infected, as I don’t know the specific situation, I can’t evaluate the degree of infection here, but I can suggest a little bit about the problem you mentioned. 1. Infection is the primary problem, if the local flow of “yellow water” indicates poor wound healing, control intracranial infection and local infection of the wound in order to heal. 2. If the infection has been clear bacteria through the bacterial culture, and through the effective antibiotics systemic application in sufficient quantities, the patient’s body temperature is normal. A second surgery can be considered to remove the artificial dura and repair the dural defect with autologous tissue (e.g., broad fascia). In other words, the presence of the artificial dura is detrimental in conditions where the local wound is infected. Patient: My third brother’s medical records will be brought back in the next few days, and I can upload them to you then. Because we all earn some money by working, we want to return to Mianyang, Sichuan for treatment and to save some money, so it is more difficult to come to Beijing for medical treatment. I don’t know if Sichuan Huaxi, preferably Mianyang, has the ability to do so. If not, maybe we will consider coming to Beijing or ask you to come to Mian? Thank you very much! Doctor: Your third brother’s situation is certainly not a problem in Huaxi, Mianyang should also be no problem, just need to be more patient and more careful by the specific doctor! The determination of the second surgery also depends on the support of the family, the second surgery if not successful is easy to incur the dissatisfaction of the patient’s family. I am afraid that every neurosurgeon has a headache in the treatment of intracranial infections, because when there is a drug-resistant bacterial infection, there is often a situation where the intracranial concentration of sensitive antibiotics does not reach the concentration needed to control the bacteria, and the drugs that can reach sufficient intracranial concentration are not sensitive to the bacteria. I say this in the hope that you will understand correctly, communicate well with your doctor, and give your patient the best chance! In fact, the core problem of the patient is already infected. I can’t evaluate the degree of infection here because I don’t know the specific situation, but I can somewhat suggest on the problems you mentioned. 1. Infection is the primary problem, if the local flow of “yellow water” indicates poor wound healing, control intracranial infection and local infection of the wound to heal. 2. If the infection has been clear bacteria through the bacterial culture, and through the effective antibiotics systemic application in sufficient quantities, the patient’s body temperature is normal. A second surgery can be considered to remove the artificial dura and repair the dural defect with autologous tissue (e.g., broad fascia). In other words, the presence of the artificial dura is detrimental in conditions where the local wound is infected. Patient: My third brother’s medical record will be brought back in the next few days, and I can upload it to you then. Because we all earn some money by working, we want to return to Mianyang, Sichuan for treatment and to save some money, so it is more difficult to come to Beijing for medical treatment. I don’t know if Sichuan Huaxi, preferably Mianyang, has the ability to do so. If not, maybe we will consider coming to Beijing or ask you to come to Mian? Thank you very much! Doctor: Your third brother’s situation is certainly not a problem in Huaxi, Mianyang should also be no problem, just need to be more patient and more careful by the specific doctor! The determination of the second surgery also depends on the support of the family, the second surgery if not successful is easy to incur the dissatisfaction of the patient’s family. I am afraid that every neurosurgeon has a headache in the treatment of intracranial infections, because when there is a drug-resistant bacterial infection, there is often a situation where the intracranial concentration of sensitive antibiotics does not reach the concentration needed to control the bacteria, and the drugs that can reach sufficient intracranial concentration are not sensitive to the bacteria. I say this in the hope that you will understand correctly, communicate well with your doctor, and give your patient the best chance!