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  Indian J Med Microbiol
 

Figure 3: (a) Axial computed tomography (CT) scan of the brain showing compound expansile skull fracture with multiple bone fragments along the trajectory and global cerebral edema. Basal cisterns are totally effaced. This 35 - year old patient came to us within 20 mins of gunshot injury. On examination, he had Glasgow coma scale (GCS) score of 3, with open herniating brain through a complex scalp defect. (b) The patient underwent decompressive craniectomy, repair of superior sagittal sinus, wound debridement, and expansile duroplasty using pericranium and temporalis fascia. Post - operative CT scan of the brain revealed swollen brain herniating through craniectomy defect. (c) Post - operative axial CT scan of the brain (2 months after surgery) showing normal appearance of ventricles and sunken scalp flap. At that time, the patient was electively admitted for cranioplasty. He was awake and alert, speaking spontaneously, following commands, and moving all four limbs

Figure 3: (a) Axial computed tomography (CT) scan of the brain showing compound expansile skull fracture with multiple bone fragments along the trajectory and global cerebral edema. Basal cisterns are totally effaced. This 35 - year old patient came to us within 20 mins of gunshot injury. On examination, he had Glasgow coma scale (GCS) score of 3, with open herniating brain through a complex scalp defect. (b) The patient underwent decompressive craniectomy, repair of superior sagittal sinus, wound debridement, and expansile duroplasty using pericranium and temporalis fascia. Post - operative CT scan of the brain revealed swollen brain herniating through craniectomy defect. (c) Post - operative axial CT scan of the brain (2 months after surgery) showing normal appearance of ventricles and sunken scalp flap. At that time, the patient was electively admitted for cranioplasty. He was awake and alert, speaking spontaneously, following commands, and moving all four limbs