Intracerebral foreign body removal

In non-fired craniocerebral open injuries, sometimes the blade that breaks into the cranial cavity is broken or nails, iron bars, etc. penetrate into the skull, or branches, bamboo chopsticks, etc. are invaded by special types of objects that are inserted into the cranial cavity through the eyelids. Such injuries have their own characteristics in handling, so they need to be very careful. Except for the surgeon to remove the wounds during the operation, others should not be moved or tried to pull out, to prevent major bleeding when pulling out, and to lose control of the treatment. Treatment of diseases: non-fired open brain injury Indication 1. The wounded are generally in good condition. After the wound examination and skull imaging to understand the distribution of foreign bodies, surgery should be prepared. 2. The wounded are in a coma, and those with intracranial hypertension and cerebral palsy should be operated immediately. Contraindications 1. The injury is serious, manifested as deep coma, pathological respiration, blood pressure drop, pulse frequency is weak, suggesting brain stem failure, not suitable for brain debridement, supportive therapy should be performed. 2. With multiple injuries such as chest and abdomen visceral injuries, pale complexion, weak pulse, and decreased blood pressure, it is not suitable for brain debridement. Should first resist shock and treat chest and abdomen organ injury, and then go to brain debridement after the condition is stable. 3. A few days after the injury, the brain has a purulent discharge in the wound. It is not suitable for brain debridement. After the infection is controlled, the debridement is performed in the late stage. Preoperative preparation 1. When puncturing deep, when damaging large blood vessels, cerebral angiography should be performed before surgery. 2. Be careful when preparing the skin before surgery. Do not move the insert to prevent aggravation of brain damage or major bleeding. 3. Prepare blood supply supplies and instruments. Inserts should be placed near large blood vessels. Silver clips, aneurysm clips, sufficient blood, two infusion channels, and two aspirator should be prepared. If necessary, treat it with interventional radiation. Surgical procedure Scalp incision An "S" shaped incision or other suitable incision is made centering on the wound. A bilateral incision should be made in the coronal incision. 2. Skull treatment Centered on the entrance of the skull, four holes are drilled around and connected into a square bone flap. Try to reduce the movement of the bone flap and prepare to remove it with the insert. A lateral forehead bone flap should be made through the insertion of the hernia. 3. Insert removal Surgeons, assistants, and other involved surgical personnel must concentrate on preparing to control major bleeding before preparing to pull out the insert. The surgeon carefully pulls back along the longitudinal axis of the insert along with the bone flap. Once major bleeding occurs, it should not panic, quickly press the carotid artery in the neck, or control the bleeding by interventional radiation. The brain injury plate is used to retract the brain injury. If necessary, the two suction devices are simultaneously attracted to see the damaged blood vessel. According to the diameter of the tube, the clip is clipped with a silver clip or an aneurysm clip. The injury of the first segment of the internal carotid artery and middle cerebral artery should be noted after the penetrating injury, and the hemostasis is successful in close cooperation. Then the bone fragments, blood clots and inactivated brain tissue in the brain should also be removed. 4. Wound suture The dura mater is tightly sutured, the bone flap can be repositioned, and the scalp is layered and sutured. complication 1. After the injury through the sputum, it may be accompanied by eyeball damage. The ophthalmologist should be assisted. 2. Through the sputum and sacral fissure penetration, attention should be paid to the internal carotid artery, cavernous sinus and middle cerebral artery injury, and corresponding treatment.