I. Cranial defect requires cranial repair and reconstruction
Cranial defect is a common post-injury and post-operative complication in patients with craniocerebral injury. Because brain tissue loses its normal cranial barrier role and is easily injured, and cranial defect can cause various symptoms and affect the appearance, cranioplasty is often needed.
The cranial defect is often localized by labor and body position, protruding or depressed, and the brain tissue at the edge of the bone window is repeatedly damaged. The cranial cavity is a closed container, and after cranial defect, the cranial cavity’s confinement is damaged and the brain tissue is displaced by atmospheric pressure. There is swelling and pain at the beginning, and patients may have headache, dizziness, restlessness, apprehension, and lack of concentration. In the long run adults may experience slowness of reaction, memory loss, speech impairment, and physical inactivity. Epilepsy may be associated with meningeal-brain scar formation. In case of long-term skull defect with brain expansion, the brain tissue can be atrophied and cystic change, and children are prone to mental retardation. Li Xianfeng, Department of Brain, Zhangqiu Hospital of Traditional Chinese Medicine
Skull repair materials include autologous bone, metal substitutes (titanium alloy mesh is mostly used now), organic materials (bone cement, organic glass, etc.).
Cranial bone repair surgery indications.
1.The diameter of skull defect is more than 3cm;
2, local symptoms and signs are obvious or cause headache, fear and other cranial defect syndrome;
3. The defective area is aesthetically displeasing. It is recommended to perform cranial repair and molding 3-6 months after craniosynostosis.
Second, why subarachnoid hemorrhage should be treated by lumbar puncture
Subarachnoid hemorrhage is the accumulation of blood in the subarachnoid space due to various causes. The accumulation of subarachnoid hemorrhage may lead to cerebral vasospasm, neurological damage and cerebral edema, which may cause prolonged headache, dizziness, and even serious complications such as hydrocephalus.
Lumbar puncture for cerebrospinal fluid drainage is an effective treatment measure. It has the following advantages.
1.Reducing the spasm of cerebral blood vessels and cerebral edema.
2.Reducing the damage to cerebral nerve tissue from the toxic substances decomposed in the blood.
3.Reduces clinical symptoms such as headache and dizziness, thus reducing patient pain.
4.It can prevent and control subarachnoid adhesions and reduce post-injury sequelae such as hydrocephalus and subdural effusion.
5.Reduce the incidence of post-injury epilepsy.
To clarify the level of intracranial pressure and the degree of subarachnoid hemorrhage, and to guide the clinical use of drugs.
Operation timing and method: After the condition becomes stable 2-3 days after injury, do lumbar puncture daily or every other day to release the appropriate amount of cerebrospinal fluid until the cerebrospinal fluid becomes clear. It can promote the absorption of bleeding, which is conducive to rapid recovery.
Third, cranio-cerebral injury first aid common sense
Before sending the patient to the hospital, let the patient lie down, remove the pillow, turn the head to the side to prevent asphyxia caused by food inhalation when vomiting. Patients vomiting, there is blood or secretions in the mouth, let the patient lie on his side, and do not pinch or shake the head to wake up the patient, which will aggravate the degree of brain injury and bleeding. The scalp is rich in blood vessels and bleeds easily after rupture, which seems to be very messy, but just use a piece of gauze to press it with your fingers.
IV. Common sense of skull base fracture treatment and care
Skull base fracture is often accompanied by cerebrospinal fluid ear leakage or nasal leakage. Since the subarachnoid space is connected to the outside world, it is easy to have intracranial infection, so treatment and prevention of infection are especially important. Treatment is based on the application of antibiotics. The patient should be placed in the affected side and the head of the bed should be elevated appropriately by 15-30° according to the self-conscious symptoms to prevent the leakage of fluid backflow into the skull. Keep the nasal cavity and ear canal clean and unobstructed, and blockage and flushing are strictly prohibited. If there is a large amount of CSF leakage at night, estimate the amount of leakage and record it, and adjust the head position to control it. In case of nasal leakage of cerebrospinal fluid, nasal aspiration and gastric tube insertion are strictly prohibited. Picking and blowing the nose is strictly prohibited.