A Bilateral Decompressive Craniotomy after Severe Traumatic Brain Injury with Post-Operatory Hydrocephalus and Ventriculitis: A Case Report and Literature Review

Introduction: Severe traumatic brain injury is characterized by pathological external forces that disrupt or alter brain function. Globally, an estimated 50 million cases of Severe traumatic brain injury occur annually. Case presentation: This case study of an 18-year-old male patient, who suffered severe TBI in a motor vehicle accident, provides a valuable insight into the management of such cases. The patient's initial assessment revealed a Glasgow Coma Scale score of 8, asymmetric but reactive pupils, and bilateral motor strength of 3/5, with no abnormalities noted in the cranial nerves. Primary diagnosis by CT scan: severe traumatic brain injury with acute subdural hematoma in the right frontoparietal-temporal region, brain edema, and midline dislocation. Secondary findings: Acute epidural hematoma in the left frontoparietal-temporal region. Associated injuries: skull fractures, soft tissue contusions, and left lung contusion. Surgical Procedures: The patient underwent the following procedures: 1. Right decompressive craniotomy for acute subdural hematoma. 2. Left decompressive craniotomy for acute epidural hematoma. Conclusion: This case underscores the pivotal role of decompressive craniotomy in managing severe traumatic brain injury. Over the past two decades, this procedure has been instrumental in reducing secondary brain injury, enhancing cerebral perfusion, and managing elevated intracranial pressure. It has also been shown to decrease both mechanical ventilation dependence and intensive care unit length of stay, providing reassurance about its effectiveness.