Skull Surgery and Recovery After Severe Head Injury

Skull, unresponsive?

Hello, doctor.
My husband fell to the ground at work, landing on his head.
At first, he was able to stand up and walk, but within three minutes, he started to have a nosebleed and fainted.
He underwent emergency surgery to remove part of his skull on the left side, which was preserved in a freezer.
After stabilizing, he had surgery the next day for a hematoma on the right side of his brain.
However, a month has passed, and he still hasn't regained consciousness, although he does not require a ventilator and can breathe on his own.
The doctor mentioned rehabilitation and said that once the skull is replaced, his condition might improve.
However, since he hasn't woken up yet, I'm really unsure about the next steps.
The doctor also mentioned concerns about the prolonged preservation of his own skull leading to potential infection and suggested the possibility of using an artificial skull.
Is it really important to replace the skull?

Lai Hsuan, 20~29 year old female. Ask Date: 2021/03/16

Dr. Zhang Junwei reply Neurosurgery

Generally speaking, returning the skull to its original position can aid in the recovery of the patient's neurological function.
Using the patient's own bone does carry a higher risk of infection, while artificial cranial implants present a lower risk of infection as an alternative.

Reply Date: 2021/03/16

More Info

I'm sorry to hear about your husband's situation. It sounds incredibly challenging, and it's understandable that you have many questions regarding his recovery and the implications of skull surgery after such a severe head injury.

When a person suffers a traumatic brain injury (TBI) that necessitates surgery, such as the removal of a portion of the skull (a procedure known as a craniectomy), the recovery process can be complex and varies significantly from person to person. In your husband's case, the fact that he was able to stand and walk immediately after the fall is a positive sign, but the subsequent loss of consciousness and the need for emergency surgery indicate a serious injury.

The primary goal of surgery in such cases is to relieve pressure on the brain caused by swelling or bleeding. The removal of the skull bone allows for this expansion without causing further damage to the brain tissue. After the initial surgery, the medical team will monitor the patient closely for signs of improvement or complications.

Regarding the timeline for recovery, it can be quite variable. Some patients may regain consciousness within days, while others may take weeks or even months. The fact that your husband is breathing independently is a good sign, but the duration of his unconscious state can be concerning. Rehabilitation is crucial, and it typically begins as soon as the patient is stable enough to participate. This can include physical therapy, occupational therapy, and speech therapy, depending on the specific needs of the patient.

As for the skull bone that has been frozen, there are indeed risks associated with keeping a bone graft or the original skull bone in a frozen state for an extended period. The primary concern is the potential for infection or complications related to the viability of the bone. If the original skull piece is deemed unsuitable for reattachment due to these risks, the medical team may recommend using a synthetic material or a custom-made prosthetic skull to cover the area.

The decision to replace the skull bone is significant. It serves not only to protect the brain but also to restore the normal shape of the head and prevent complications such as cerebrospinal fluid leaks or infections. If the skull is not replaced, there may be ongoing issues with brain protection and potential long-term neurological deficits.

In terms of next steps, it’s essential to maintain open communication with your husband’s medical team. They can provide specific guidance based on his condition and progress. Asking about the timeline for skull replacement, the risks involved, and the rehabilitation process will help you understand what to expect moving forward.

In summary, while the recovery from such a severe head injury can be daunting, there are many factors that can influence outcomes positively. Continuous monitoring, rehabilitation, and timely surgical interventions are critical components of the recovery process. Your husband's medical team will be the best resource for tailored advice and support as he navigates this challenging journey.

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