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Przejdź do opcji czytnikaPrzejdź do nawigacjiPrzejdź do informacjiPrzejdź do stopki
ZDROWIEIBEZPIECZEŃSTWO2/2019
causedchangesinthechild’sbehavior:animpulsiveandjoyfulboyturned
intoanaggressiveandhaughtyone.On23April2012aright-sidedfronto-
-orbitalcraniotomywasperformedunderthegeneralintratrachealanaesthe-
sia.Teduramaterwasseparatedfromtheorbitalroof.Abonewasbittenof
theorbitalroofinthedirectionofitsapex.Teperiorbitalareawasincised.
Aforeignbody,i.e.apieceofwood,waslocalizedattheorbitalapexbehind
theuppertrochlearmuscleandabovetheupperrectus,andsubsequentlyre-
moved.Homeostasiswascontrolled.Tesurgicalsitewasrinsedofwiththe
watersolutionofbetadine.Asuturewasplacedontheperiorbitalarea.Te
duramaterwasincisedinthesectionoftheeyebrowarch,theanteriorcra-
nialfossabasewaselevated,andthecerebralcortexdamageswerelocalized
laterallyawayfromtheolfactorystria.Anincisionofthecerebralcortexwas
widenedandatthedepthof0.5cmaformingsack-surroundedabscesswas
found.Teabscesswastotallyremoved,preparingonthegliosisplanethat
surroundedtheabscesssac.Aduraplastyofthecranialbasewasperformed
withaTachocombplacedinasandwich-likemanner.Awater-tightsuturewas
appliedupontheduramater.ApatchofTachocombwasplacedonthesuture
line.Bonefragmentswereputinplaceandfastenedbymeansofsuturesand
aCranioFixtitaniumclamp.Itwasarrangedthatthechildwillnotbewoken
upbutheremainedunderthecontrolledbreathing,andthenhewastrans-
ferredtotheIntensiveCareUnitIIinordertoundergofollow-uptreatment.
Inthenexttwenty-fourhoursfollowingtheoperationthechildwasconscious.
Onphysicalexaminationitwasfoundthattheoedemamadeitimpossibletoas-
sesshisrightpupil.Awidespectrumofantibiotictherapywasapplied.After
theoperation,thepatientwassubjecttodailyneurologicalrehabilitation.Te
boyreceivedtheremovedpieceofwoodasasouvenir.Beforethephotowas
takenthepreparationwascleansedfromthemould
forabettervisibility(figure3).
Figure3.Aphotoofapieceofwoodremovedduring
thecraniotomy
Source:theauthors’ownmaterial.
AGNIESZKASUPRONOWICZ,PAWEŁIWACEWICZ,MONIKAOLSZEWSKA
PENETRATINGCRANIOCEREBRALTRAUMAINACHILDCASESTUDY
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