Case Report Turkish Neurosurgery 2013, Vol: 23, No: 3, 401-403 401 Received: 17.11.2011 / Accepted: 01.12.2011 DOI: 10.5137/1019-5149.JTN.5474-11.0 ABSTRACT With modern technology, intraoperative computed tomography scans are being used in neurosurgical operative rooms. A case of severe head trauma is reported to underline how intraoperative computed tomography can improve the treatment of traumatic lesions, without changing the operative setup, with safety for patients and surgeons. The ability to perform an intraoperative computed tomography scan rapidly, at any surgical step, and with no need of any change in the operative room set or of moving the patient from the operative table improves safety both for the patient and surgeon. Intraoperative computed tomography is a very helpful tool during surgery for complex cases when a rapid evaluation of surgical manoeuvres is required. KEYWORDS: Intraoperative computed tomography, Head trauma, Hematoma, Mobile computed tomography, Ceretom ÖZ Modern teknolojide intraoperatif bilgisayarlı tomografi taramaları nöroşirürji ameliyathanelerinde kullanılmaktadır. İntraoperatif bilgisayarlı tomografinin hastalar ve cerrahlar için ameliyathane kurulumunu değiştirmeden travmatik lezyonların tedavisini güvenli bir şekilde nasıl geliştirebileceğinin ana hatlarını vermek üzere örnek olabilecek bir ciddi kafa travması vakası bildirilmektedir. Cerrahi sırasında çok az süre içinde ve cerrahi kurulumda herhangi bir modifikasyon yapmadan istendiği zaman intraoperatif bilgisayarlı tomografi yapabilmek cerrahi protokol ve iş akışında bir değişiklik gerektirmeden hasta ve cerrahın güvenliğini arttırır. İntraoperatif bilgisayarlı tomografi cerrahi sırasında cerrahi manevraların hızla değerlendirilmesi gerektiğinde karmaşık vakalar için çok faydalı bir araçtır. ANAHTAR SÖZCÜKLER: İntraoperatif bilgisayarlı tomografi, Kafa travması, Hematom, Mobil bilgisayarlı tomografi, Ceretom Corresponding Author: Graziano TADDEI / E-mail: merut82@gmail.com Graziano TADDEI 1 , Alessandro RICCI 1 , Francesco DI COLA 1 , Giuliano MASELLI 1 , Sara MARZI 1 , Renato J. GALZIO 1,2 1 S. Salvatore Hospital, Department of Neurosurgery, L’Aquila, Italy 2 University of L’Aquila, Health Sciences, L’Aquila, Italy e Usefulness of Intraoperative Mobile Computed Tomography in Severe Head Trauma Şiddetli Kafa Travmasında İntraoperatif Mobil Bilgisayarlı Tomografinin Faydası INTRODUCTION Intraoperative computed tomography (iCT) is not widely used in the neurosurgery operative room (OR). However, current iCT systems are small, light, and can be easily carried in and out of the OR. Moreover, there is no need of special equipment due to the low radiation dose emitted. Some author have reported iCT helpfulness in the OR, intensive care unit (ICU) and Emergency Room (ER) (1,3,4,6). The aim of this case report is to emphasize the role of iCT during surgery for severe head trauma. CASE REPORT A 52-year-old man was presented at the ER as the victim of a car accident. He was in comatose state with a Glasgow Coma Score of 5 (E1,V1,M3) and anisocoric pupils. The patient was sedated and intubated and underwent our diagnostic protocol for trauma. The abdominal study did not show any disorders and the whole spine evaluation did not detect fractures. The head conventional Computed Tomography is shown in Figure 1. The patient was transferred to the OR to undergo surgical evacuation of the right subdural hematoma and wide decompressive craniotomy. During this procedure an unexpected important brain swelling was noted so an iCT was performed demonstrating the presence of both contralateral subdural and epidural hematomas (Figure 2A,B). Therefore, a further surgical procedure was needed and the final iCT control is shown in Figure 3. After the two surgical procedures, the patient recovered at the ICU with isocoric pupils. DISCUSSION In case of severe head trauma, a shorter time for diagnosis and treatment is the best way to improve outcome. Carrying out an iCT exam in OR allows obtaining faster diagnostic images which allow an increase of treatment quality and safety. Moving a ventilated and sedated patient from the OR to the CT room prolongs the time spent to diagnose a probable complication, increasing the risks of secondary brain injuries (4).