TITLE:
Unilateral Bone Window Cerebral Falx Incision of Bilateral Frontal Lobes Cerebral Contusion and Laceration under Neuroendoscopy and Literature Review
AUTHORS:
Gang Yang, Shaojun Yang, Chao Gu, Chenbing Wang, Lulu Weng
KEYWORDS:
Neuroendoscopy, Cerebral Falx Incision, Bilateral Frontal Lobes Cerebral Contusion and Laceration
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.11 No.3,
July
15,
2021
ABSTRACT: Background: Bilateral frontal lobes cerebral contusion and
laceration is one unique brain injury in neurosurgery department. It is
characteristic of recessive attacking and develops quickly. The unilateral
cerebral falx incision is a new minimally invasive surgery that can solve bilateral frontal lobes cerebral contusion and laceration in
one surgery. However, it has some limitations in removal of contralateral
frontal hematoma and hemostasis due to the limited field of view under the
microscope. The unilateral bone window cerebral falx incision of bilateral
frontal lobes cerebral contusion and laceration under a neuroendoscopy can
acquire a good illumination and field of view. This is beneficial to complete
removal of contralateral hematoma, effective hemostasis and retaining brain
tissue functions to the maximum extent. Case Presentation: The patient,
a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because
of car accident”. Physical Examination: Coma, GCS score of E1V2M5,
bilateral pupil diameter of 2 mm, presence of light response, contusion of
scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome
negative. The patient has a history of non-traumatic cerebral stroke 3 years
ago. Head CT: Longitudinal fracture of frontal parietal occipital bone,
bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. Diagnosis: Bilateral frontal lobes contusion and laceration, longitudinal fracture of
frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp.
In emergency treatment, unilateral bone window cerebral falx incision of bilateral
frontal lobes cerebral contusion and laceration under a neuroendoscopy was
performed. The surgery has achieved satisfying effect. Discussion: This case
realized the goal of removing contralateral frontal hematoma through unilateral
craniotomy under a neuroendoscopy. Due to the clear field of view, it retained
extracerebral layer structures of contralateral olfactory nerve protection frontotemporal
completely. Moreover, this surgical technique is conducive to intraoperative
recognition of pericallosal arteries and lateral fractured blood vessels. It also involves
protection, which conforms to the minimally invasive philosophy. The proposed
surgical technology can eliminate contralateral frontal hematoma under a good
field of view. However, it is suggested not to manage with the further
operation on patients who have brain swelling and difficulties in exposure of
cerebral falx. These patients need to determine causes of brain swelling and
choose bilateral craniectomy if necessary. Conclusions: Unilateral bone
window cerebral falx incision of bilateral frontal lobes cerebral contusion and
laceration under a neuroendoscopy is a new application of minimally invasive
philosophy in craniocerebral injury operation. It still needs further clinical
verifications and experience accumulation.