Open craniocerebral injury refers to the damage to the skull and dura mater, where the brain tissue is directly or indirectly exposed to the external environment. It accounts for approximately 17% of craniocerebral injuries. In daily life, it is often caused by sharp or blunt objects, falls, or impacts, while in wartime, it is mostly caused by firearms. The clinical manifestations vary widely depending on the cause, method, and severity of the injury, but most cases involve varying degrees of unconsciousness, bleeding from the wound or injury tract, localized brain symptoms, and a high susceptibility to infection, especially in firearm-related craniocerebral injuries. These injuries are often severe, progress rapidly, respond poorly to treatment, result in numerous sequelae, and have a high mortality rate.

bubble_chart Clinical Manifestations

1. Scalp laceration, bleeding in the wound or wound tract, visible bone fragments and other foreign bodies, sometimes cerebrospinal fluid fistula disease and brain tissue spillage, massive bleeding may lead to shock.
2. Most cases experience unconsciousness after injury, some of which are due to extensive cerebral contusion and brainstem injury. A few cases may not experience unconsciousness but can develop symptoms of increased intracranial pressure due to intracranial hematoma, leading to secondary unconsciousness.
3. Focal neurological symptoms such as hemiplegia, aphasia, and focal epilepsy.
4. Prone to complications such as wound tract infection, leading to intracranial purulent inflammation and brain abscess.

bubble_chart Diagnosis

1. There is a history of head injury, with visible wound tract bleeding, and in some cases, cerebrospinal fluid and brain tissue leakage.
2. Often unconsciousness, with a few cases showing no unconsciousness.
3. Focal brain symptoms such as hemiplegia, aphasia, focal epilepsy, etc.
4. Some patients may exhibit signs of increased intracranial pressure due to intracranial hematoma or infection.
5. Skull X-rays reveal skull fractures, intracranial foreign bodies (such as bone fragments, shrapnel, or bullets, etc.), while head CT and MRI scans can show cerebral contusions, lacerations, and hematomas.

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bubble_chart Treatment Measures

1. Timely debridement and treatment.
2. Use antibiotics to prevent infection.
3. Prevent cerebral edema.
4. Symptomatic supportive treatment.

After an open craniocerebral injury occurs, because the brain tissue is exposed to the external environment, intracranial infection is highly likely. Therefore, the wound should be promptly covered with clean dressing to protect it from contamination. When there is active bleeding from the scalp, pressure dressing or suturing can be used to stop the bleeding to prevent hemorrhagic shock. For those with excessive blood loss, timely blood transfusion and fluid replacement are necessary to restore blood volume. Meanwhile, the injured should be quickly transported to the hospital. Unconscious patients should be placed in a lateral position to facilitate the drainage of oral and respiratory secretions and vomit, which is crucial for maintaining airway patency. Head X-rays and CT scans have high diagnostic value for craniocerebral injuries and should be prioritized as the first-choice examination. Timely debridement should be performed, combined with antibiotics that easily cross the blood-brain barrier to prevent infection. Once intracranial infection occurs, inflammatory secretions or pus should be collected for bacterial culture and drug sensitivity testing, and effective antibiotics should be selected for treatment.

bubble_chart Cure Criteria

1. Cure: Wound healing, clear consciousness, symptoms and signs disappear, return to normal life and work, may leave cranial defects.
2. Improvement: Wound healing, improved or clear consciousness, partial recovery of symptoms and signs, basic or partial self-care in daily life, some work ability or partial loss of labor capacity.
3. No cure: Wound not healed, no improvement or worsening of consciousness, symptoms and signs.