A 26-year-old male, with no relevant past medical history, suffered a road accident.
Perform a medicalized ambulance in GCS of 4 points (M2-O1-V1).
Sedation, intubation and transfer to our center were performed.
On admission computed tomography (CT) showed bilateral extraaxial hemorrhagic base with bilateral extension in right internal capsule and another in left internal capsule and caudaco nucleus caudacoparum; diffuse cerebral edema with obliteration of the skull base small fracture time
It was decided to monitor the patient with an intracranial pressure (ICP) sensor and another oxygen tissue pressure sensor placed in the right frontal lobe.
Initial ICP levels were high, but could be controlled with sedation and relaxation.
However, starting 48 hours after admission, ICP increased again, so a control cranial CT scan was performed (third from admission), which showed an increase in the right contusion and a temporoparietal volume of approximately 28 ml.
Surgical intervention was decided, and a right frontotemporal craniotomy and contusion evacuation were performed.
The impossibility of closing the dura by a considerable swelling of the brain was not observed.
After surgery, ICP was controlled and all therapeutic measures could be progressively removed.
The patient was discharged after 20 days with a GCS of 10 points (O4-M5-V1).
During surgery, images of the microdislocation were recorded.
Previously, the research committee of our hospital had approved the study.
Also, the patient used as control and the relatives of the patient of the clinical case signed the informed consent; in both cases they authorized the performance of the technique.
After evacuation of the contusion and before starting the closure by planes, 8 10-s sequences were recorded. The recordings were made on the cerebral cortex, at the limit of the penu refused surgical resection.
1.
The control patient was a 51-year-old male with no relevant medical history who underwent elective surgery for an incidental brain aneurysm of the right middle cerebral artery.
There were no lesions of any type in the parenchyma, so we consider it a good example of the normal state of cerebral microarray.
The images shown were also obtained on the cerebral cortex of the frontal and temporal lobes.
1.
When comparing both images, it can be seen that the background in Figure 1 is black due to the large quantity of extravasated particles.
In addition, Figure 1 shows a picture in the form of screen that could correspond to the pia-arachnoids.
The greatest difference between both images is vessel density.
Figure 1 shows only vessels, although the image corresponds to the pericontusional cerebral cortex.
Moreover, the few vessels observed are difficult to identify when comparing this image with the control patient.
Numerically, these differences are shown in Table 1.
The total length of vessels in the control patient was 5,120 μm and 625 μm in the trauma patient.
Regarding density, in the control case, vessels occupy 14.17% of the total area of the image, while in the TBI patient, only 2.51%.
