Traumatic Intracerebral Haematoma: complication of skull caliper traction

Summary

Recently, a unique case[*] of traumatic intracerebral haematoma complicating the insertion of skull calipers, has been observed. It is assumed it was due to: 1. the accidental penetration of the burr into the skull, while making the insertion hole for the caliper; 1. the failure to grip the skull with the special metal sleeve, the Blackburn skull caliper is provided with, so that the end plates were free to move in and out of the skull in this restless patient.

The correct diagnosis was made only after severe uncal herniation had developed. The reasons for missing the correct diagnosis within useful time for proper treatment are considered to be: 1. carotid angiography performed too early in the process of haematoma formation: 2. the vascular displacements were only slight and not fully diagnostic; 3. a recognized complication, extradural haematoma, had already been excluded.

Zusammenfassung

Kürzlich wurde ein einmaliger Fall eines traumatischen intrazerebralen Hämatoms nach Anlegen eines Extensionsbügels am Schädel beobachtet. Es konnte gesichert werden, daß es zustande kam 1. durch die versehentliche Penetration des Bohrers in das Schädelinnere während des Anlegens des Bohrloches für den Bügel, 2. durch Weglassen des speziellen Metallschutzes, mit dem der Blackburn-Schädelbügel versehen ist, so daß bei der unruhigen Patientin die Enden sich frei im Schädel hin und her bewegen konnten.

Die exakte Diagnose wurde erst gestellt, als sich eine Uncushernie entwickelt hatte. Die Gründe für die zu späte Diagnose sind: 1. Die Carotis-Angiographie wurde zu früh während der Hämatomentwicklung durchgeführt. 2. die vaskulären Dislokationen waren nur sehr gering und nicht ausreichend diagnostisch zu verwerten, 3. eine mögliche Komplikation, ein extradurales Hämatom, war ausgeschlossen worden.

Key-words

fracture dislocation of the cerebral spine - skeletal traction - intracerebral haematoma

1 Charles G. Drake, J. Neurosurg. 19, 1962, p. 489 briefly mentions a patient who had this lesion, among three patients sent to his service with complications from the application of calipers. “However, the second had a penetrating brain wound with an intracerebral clot, and, in the third, the point had torn the middle meningeal artery …”

1 Charles G. Drake, J. Neurosurg. 19, 1962, p. 489 briefly mentions a patient who had this lesion, among three patients sent to his service with complications from the application of calipers. “However, the second had a penetrating brain wound with an intracerebral clot, and, in the third, the point had torn the middle meningeal artery …”