The Surgical Treatment Of Intracranial Hematoma Patients Caused By Craniocerebral Trauma Combined With Hemostatic Abnormalities

Objective No reports in treating the intracranial hematoma patients caused by craniocerebral trauma combined with hemostatic abnormalities can be found. Here we report four such cases which were treated successfully to sum up the experience of diagnosis and surgical treatment of brain hernia caused by craniocerebral trauma combined with hemostatic abnormalities, in order to increase the level of surgical treatment of these special diseases.Method The four patients admitted to Qilu hospital due to intracranial hematoma caused by craniocerebral trauma combined with hemostatic abnormalities undergoing emergency craniotomy were retrospectively studied in the past two years. The surgical treatment and principles of perioperative was summarized with respect to the appropriate therapy regimen for these special diseases, combined with the literature at home and abroad. The two patients with hemophilia A, one patient with idiopathic thrombocytopenia purpura (ITP) and one patient with thrombocytopenia of unknown origin were demonstrated with brain hernia due to craniocerebral trauma. The diagnosis of craniocerebral trauma with intracranial hemorrhage (ICH) was confirmed by CT. After timely dehydration and platelet/cryoprecipitate transfusion within 3 hours to correct the disturbance of blood coagulation, the emergency craniotomy was performed to remove the intracranial hematoma.Results Generally, the intracranial hematoma of all the four patients was cleaned remarkably without secondary hemorrhage. Two patients with hemophilia A recovered and discharged. One patient with ITP improved and was transferred to hematology department for further therapy. Another patient with thrombocytopenia of unknown origin discharged automatically with removal of stitches after waking postoperatively.Conclusions Neurosurgical intervention to the abnormity of Hemostatic mechanism with cerebral hernia caused by brain injury is rare, because of high risk and high mortality. However, on the temporary achievement of normal hemostatic condition, the dedicated and standard perioperative management is the key to ensure the effective surgical treatment and ideal prognosis.