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
https://doi.org/10.56618/2071-2693-2025-17-1-98
EDN: UNEKXA
Abstract
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.
About the Authors
V. V. Shkolnikov
1469 Naval Clinical Hospital
Russian Federation
Russian Federation
Vladislav V. Shkolnikov – Senior Resident at the Neurosurgical Department
1 Murmanskoye highway, Severomorsk, 184606
K. N. Babichev
Military Medical Academy named after S. M. Kirov; Saint-Petersburg Institute of Emergency Care n. a. I. I. Dzhanelidze
Russian Federation
Russian Federation
Konstantin N. Babichev – Neurosurgeon at the Neurosurgery Clinic, Military Medical Academy named after S. M. Kirov (St. Petersburg, Russia); Junior Researcher at the Department of Neurosurgery, Saint-Petersburg Institute of Emergency Care n. a. I. I. Dzhanelidze
6 Academician Lebedev street, St. Petersburg, 194044
3 Budapestskaya street, St. Petersburg, 192242
D. V. Svistov
Military Medical Academy named after S. M. Kirov
Russian Federation
Russian Federation
Dmitriy V. Svistov – Cand. of Sci. (Med.), Head at the Department and Clinic of Neurosurgery, Military Medical Academy named after S. M. Kirov; Chief Neurosurgeon of the Ministry of Defense of the Russian Federation
6 Academician Lebedev street, St. Petersburg, 194044
References
1. Military field surgery. National leadership; eds by I. M. Samokhvalov. 2nd ed. Moscow: GEOTAR-Media; 2024, pp. 532–622. (In Russ.).
2. Cherian I., Bernardo A., Grasso G. Cisternostomy for Traumatic Brain Injury: Pathophysiologic Mechanisms and Surgical Technical Notes. World Neurosurg. 2016;(89):51–57. Doi: 10.1016/j.wneu.2016.01.072.
3. Chandra V. V. R., Mowliswara Prasad B. C., Banavath H. N., Chandrasekhar Reddy K. Cisternostomy versus Decompressive Craniectomy for the Management of Traumatic Brain Injury: A Randomized Controlled Trial. World Neurosurg. 2022;(162):e58–e64. Doi: 10.1016/j.wneu.2022.02.067.
4. Tkachev V. V., Shagal L. V., Muzlaev G. G. The use of transcallosal ventriculostomy to treat complicated forms of aneurismal intracranial hemorrhages. Burdenko’s Journal of Neurosurgery. 2015;79(1):48–57. (In Russ.). Doi: https://doi.org/10.17116/neiro201579148-57.
5. Khrapov Yu. V., Alekseev D. E., Svistov D. V. A new concept of organization and scope of neurosurgical care in the US army during armed conflicts in the early 2000s. Burdenko’s Journal of Neurosurgery. 2017;81(1):108–117. (In Russ.. Doi: 10.17116/neiro2017807108–117.
6. Bell R. S., Mossop C. M., Dirks M. S. et al. Early decompressive craniectomy for severe penetrating and closed head injury during wartime. Neurosurg Focus. 2010;28(5):E1. Doi: 10.3171/2010.2.FOCUS1022.
7. Tanriover N., Ulm A. J., Rhoton A. L. Jr., Yasuda A. Comparison of the transvermian and telovelar approaches to the fourth ventricle. J Neurosurg. 2004;101(3):484– 498. Doi: 10.3171/jns.2004.101.3.0484.
8. Babichev K. N., Stanishevskiy A. V., Svistov D. V. et al. Surgical resection of fourth ventricular tumors. Comparison of the efficiency and safety of telovelar and median aperture approaches to the fourth ventricle. Neyrokhirurgiya = Russian Journal of Neurosurgery. 2018;20(4):10–19. (In Russ.).
9. Hanaei S., Maroufi S. F., Sadeghmousavi S. et al. Telovelar vs. Transvermian approach for the fourth ventricle tumors: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2024;(240):108259. Doi: 10.1016/j.clineuro.2024.108259.
10. Pitskhelauri D., Sufianov R., Konovalov A., Pronin I., Sanikidze A. Median trans-atlanto-occipital membrane microsurgical approach to the posterior cranial fossa without craniotomy. J Neurosurg. 2022;138(2):374–381. Doi: 10.3171/2022.5.JNS22111.
Review
For citations:
Shkolnikov V.V., Babichev K.N., Svistov D.V. 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. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2025;17(1):98-106. (In Russ.) https://doi.org/10.56618/2071-2693-2025-17-1-98. EDN: UNEKXA
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