The removal of a hematoma of the fourth ventricle using median trans-atlanto-occipital membrane microsurgical approach to the posterior cranial fossa without craniotomy in patient after penetrating brain injury: clinical case and literature review

Combat gunshot wounds of the brain differ from injuries usual for neurosurgery in the presence of many traumatic factors: exposure to a blast wave, high temperature, flame, metal effect of an explosion, etc. The structure of a gunshot wound is determined by the type, size and number of wounding projectiles, their kinetic energy, localization and the trajectory of the injury. As a result, many variants of injury are formed, which in some cases require modification of standard treatment and the application of the concept of “damage” control. This article describes a clinical case of a patient with a penetrating head injury with severe brain damage, complicated by total intraventricular hemorrhage. As one of the components of surgical treatment the removal of an intraventricular hematoma from the fourth ventricle using median trans-atlanto-occipital membrane microsurgical approach to the posterior cranial fossa without craniotomy. According to our data, this is the first case of using this approach in emergency neurosurgical practice, especially for traumatic brain injuries.