Dr. Osborn has performed thousands of brain surgeries, a large percentage for traumatic brain injuries. These include, but are not limited to, craniotomies for depressed skull fractures, epidural and subdural hematomas in the wake of falls, high-speed motor vehicle accidents, and ballistic injuries.
The illustrative case is a patient who presented to a local trauma center after an unhelmeted motorcycle accident. At the time of arrival, he underwent a CT scan of the brain (left) that revealed a large right frontoparietal epidural hematoma (red arrows) with mass effect and midline shift (a sign of impending brain herniation).
The patient was emergently intubated and taken to the operating for surgical intervention. He underwent a right-sided craniotomy, evacuation of the epidural hematoma, and placement of an intracranial pressure (ICP) monitor. As his skull was fractured in numerous pieces (comminuted), the patient underwent a wire mesh cranioplasty to protect the underlying brain and optimize cosmesis.
The patient was maintained in the ICU for several weeks postoperatively and ultimately transferred to an inpatient rehabilitation facility. The postoperative CT scan performed eight weeks after surgery is seen on the left. The blue arrow denotes the titanium mesh (cranioplasty). The epidural hematoma (red arrows on the above preoperative CT) has been completely evacuated, and the midline shift has resolved.
The patient is faring well and has returned to preoperative baseline aside from deficits related to a brachial plexus injury, an often-encountered problem in motorcycle accident victims.