Hybrid emergency room（ER）にて初期治療したクロスボウによる頭部穿通性外傷の１例

大山 裕太; 大井川 秀聡; 大貫 隆広; 指田 涼平; 木倉 亮太; 井上 雄貴; 中里 一郎; 廣川 佑; 川口 愛; 高屋 善德; 藤原 廉; 朝見 正宏; 後藤 芳明; 石川 久; 宇野 健志; 田中 純一; 大山 健一; 小野田 恵介; 山根 文孝; 安心院 康彦; 三宅 康史; 坂本 哲也; 松野 彰; 辛 正廣

doi:10.32187/neurotraumatology.44.2_44

Case Report

A case of penetrating head injury caused by a crossbow that was initially treated in hybrid emergency room

Yuta Oyama, Hidetoshi Ooigawa, Takahiro Onuki, Ryohei Sashida, Ryota Kikura, Yuki Inoue, Ichirou Nakazato, Yu Hirokawa, Ai Kawaguchi, Yoshinori Takaya, Ren Fujiwara, Masahiro Asami, Yoshiaki Goto, Hisashi Ishikawa, Takeshi Uno, Junichi Tanaka, Kenichi Oyama, Keisuke Onoda, Fumitaka Yamane, Yasuhiko Ajimi, Yasufum Miyake, Tetsuya Sakamoto, Akira Matsuno, Masahiro Shin

Author information

Yuta Oyama [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine [Japan]
Hidetoshi Ooigawa [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University [Japan]
Takahiro Onuki [Japan]
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine [Japan]
Ryohei Sashida [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Ryota Kikura [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Yuki Inoue [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Ichirou Nakazato [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Yu Hirokawa [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Ai Kawaguchi [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Yoshinori Takaya [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Ren Fujiwara [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Masahiro Asami [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine [Japan]
Yoshiaki Goto [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Hisashi Ishikawa [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Takeshi Uno [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Junichi Tanaka [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Kenichi Oyama [Japan]
Department of Neurosurgery, International University of Health & Welfare [Japan]
Keisuke Onoda [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Fumitaka Yamane [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]
Department of Neurosurgery, International University of Health & Welfare [Japan]
Yasuhiko Ajimi [Japan]
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine [Japan]
Yasufum Miyake [Japan]
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine [Japan]
Tetsuya Sakamoto [Japan]
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine [Japan]
Akira Matsuno [Japan]
Department of Neurosurgery, International University of Health & Welfare [Japan]
Masahiro Shin [Japan]
Department of Neurosurgery, Teikyo University School of Medicine [Japan]

Keywords: Penetrating trauma, Hybrid emergency room, Crossbow, Cytotoxic lesion of the corpus callosum

JOURNAL FREE ACCESS

2021 Volume 44 Issue 2 Pages 44-49

DOI https://doi.org/10.32187/neurotraumatology.44.2_44

Details

Abstract

Background: We experienced a case of head penetrating injury caused by a crossbow that was initially treated in the Hybrid Emergency Room (ER).

Case: A 25–year–old male who lost consciousness and was collapsed in his room with penetrating crossbow in his head, was transported to our hospital. After routine checkups, the patient was immediately move to the Hybrid ER. A head CT and digital subtraction angiography (DSA) was performed and no obvious injury in the intracranial major vessels was confirmed. The crossbow was safely removed there. The patient was then moved to the central operating room and underwent a relevant surgical procedure. Postoperative diffusion–weighted MRI showed a high–signal area in the corpus callosum and disorders of consciousness continued for a while. The corpus callosum lesion was determined to be cytotoxic lesion and the patient was followed up. His conscious state gradually improved and the abnormal signal in the corpus callosum disappeared on the 40th hospital day. On the 91st hospital day, the patient was transferred for additional rehabilitation.

Conclusion: A Hybrid ER is one of a surgical unit installing CT and DSA. The ability of multimodal medical treatment is useful to traumatic brain injury, especially penetrating head injury for which we often need to carry out flexible surgical procedure.

Corresponding author

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