Non-powder lateral penetrating craniocerebral gunshot wound in a 10-year-old girl: A case reportIntroduction: Non-powder lateral penetrating craniocerebral gunshot wounds (PCGW) is one of the lethal types of penetrating head injury. The mortality rate is higher in adults than in pediatric populations and influenced by the clinical and radiologic findings as to the important predictors for prognostication in patients with PGCW. Case presentation: A 10-year-old girl presented with a gunshot wound to the head 1 day prior. She was accidentally shot by her brother with an air gun from approximately 2 feet from the gun barrel. She develops a loss of consciousness for 30 minutes and weakness over the left arm. On physical examination, the Glasgow Coma Scale (GCS) was E3V5M6, weakness on the left arm, and an entrance wound over the right temple without an exit wound. The skull X-ray showed the pellet fragment and the computed tomography (CT) scan showed the bullet track starting from the right frontotemporal towards the left parietooccipital region, damaging both hemispheres with associated intraventricular hemorrhage (IVH). She was undergone a craniotomy procedure to remove the bullet fragment, debridement of the necrotic tissue, and evacuate the blood clot over the bullet track. The patient was discharged after postoperative day 7 with good recovery of neurological function and good GCS and Glasgow Outcome Scale (GOS) score. After 6 months of follow-up, neither a new deficit nor other signs and symptoms were developed. Conclusion: Non-powder PCGW can cause significant damage to the intracranial compartment, despite its low velocity. The mortality rate in pediatrics is lower than in the adult population. The management mandated an urgent surgical procedure to remove any blood clot and debridement of any foreign bodies encountered. Such complications in the short-or long term can be developed in any patient and should be treated expectantly.
BACKGROUNDGerminoma is the most common type of germ cell tumor that develops intracranially. Germinomas usually grow in the midline structures, such as the pineal and suprasellar regions, and are rarely found in other locations. To the best of the authors’ knowledge, no previous research has reported on growth of this tumor in the cranial vault.OBSERVATIONSThe authors reported an unusual case of primary cranial vault germinoma in a young adult. Macroscopically, the tumor had a solid-soft consistency and grayish color with brownish spots on the surface. The histological examination revealed anaplastic cells with round, hyperchromatic, pleomorphic nuclei; prominent nucleoli; and abundant, clear cytoplasm, arranged in lobules and sheets that were infiltrated by lymphocytes and separated by fibrous connective tissue. These findings were consistent with the histopathological characteristics of germinoma.LESSONSPrimary cranial vault germinoma is a unique tumor because no previous research has reported any growth in that location. It should be considered one of the differential diagnoses of lesions located over the cranial vault. Histopathological examination is still the primary modality for diagnosing these tumors and excluding other differential diagnoses.
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