Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4314-4320
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4314
Mass brain tissue lost after decompressive craniectomy: A case report
Guang-Gang Li, Zhi-Qiang Zhang, Yan-Hong Mi
Guang-Gang Li, Yan-Hong Mi, Department of Critical Care Medicine, 7th Medical Center of PLA General Hospital, Beijing 100700, China
Zhi-Qiang Zhang, Department of Radiology, 7th Medical Center of PLA General Hospital, Beijing 100700, China
Author contributions: Li GG wrote the manuscript; Zhang ZQ collected the medical imaging data; Mi YH collected the patient history data; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guang-Gang Li, MM, Associate Chief Physician, Associate Professor, Department of Critical Care Medicine, 7th Medical Center of PLA General Hospital, No. 5 Nanmencang Street, Dongcheng District, Beijing 100700, China. leegangr@foxmail.com
Received: December 6, 2021
Peer-review started: December 6, 2021
First decision: January 25, 2022
Revised: January 30, 2022
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: May 6, 2022
Processing time: 144 Days and 19.2 Hours
Abstract
BACKGROUND

The brain is the most important organ to maintain life. However, the amount of brain tissue required for maintaining life in humans has not been previously reported.

CASE SUMMARY

A 33-year-old woman fell from the third floor three months before admission to our department. She received a decompressive craniectomy soon after injury. After the operation, operative incision disunion occurred due to the high pressure. Brain tissue flowed from the incision, and intracranial infection occurred. She fell into deep coma and was sent to our hospital. Her right temporal surgical incision was not healed and had a cranial defect of 10 cm × 10 cm. Her intracranial cavity was observed from the skull defect, and the brain tissue was largely lost. In addition, no brain tissue was observed by visual inspection. Cranial computed tomography showed that only a small amount of brain tissue density shadow was compressed in the cerebellum and brainstem. Four days after hospitalization in our hospital, her parents transferred her to a hospital near her hometown. The patient died six days after discharge from our hospital.

CONCLUSION

This rare case provides some proof of the importance of the brainstem in the maintenance of cardiac rhythm and vascular tension. Neurosurgeons should carefully protect brainstem neurons during operations. Clinicians can maintain the cardiac rhythm of patients who lose their major brain tissue with modern technology, but the family of the patients should be aware of death and end-life care.

Keywords: Brainstem; Brain death; Decompressive craniectomy; Case report

Core Tip: A woman got traumatic brain injury and received decompressive craniectomy. Incision disunion and intracranial infection happened after operation, mass brain tissue flowed out from incision. The patient was in deep coma and need ventilator support, her cardiac rhythm was roughly normal. No brain tissue could be seen from cranial defect. The computed tomography showed only very few brain tissue density shadow compressed in the cerebellum and brain stem, none in rest of the cranial cavity. She died a few days later. This rare case provided us some clues that cardiac rhythm and vascular tension can be maintained with very few brain tissue.