Management of Penetrating Traumatic Brain Injury: Operative versus Non-Operative Intervention

Nonmissile penetrating head injury with a wooden table leg: An illustrative case

“…Patients can also experience posttraumatic seizures and epilepsy 18 which may warrant seizure prophylaxis, such as valproic acid. Long‐standing changes in personality, cognition, and speech are commensurate with severity and location of the originating insult 19,20 . While increasing severity of traumatic brain injury corresponds to greater cognitive and functional impairment, immediate postinjury rehabilitation is recommended to reduce short‐ and long‐term consequences of these potentially devastating head injuries 21 …”

Simple Wound Closure for Civilian Cranial Gunshot Wounds: A Systematic Literature Review

“…Levy et al reported that in patients with initial GCS 3-5, there was a higher incidence of mortality in patients treated with simple wound closure compared to surgery (129/130, 99.2% versus 37/60, 61.7%; p<.000001) [ 19 ]. Similarly, D’Agostino et al reported that in patients with initial GCS 3-5, simple wound closure patients had a higher incidence of mortality compared to surgical patients (72.2% versus 18.5%; p<.0001) [ 9 ]. The same paper also reported no differences in mortality between the two treatment groups for patients with initial GCS ≥6 (8.5% wound closure versus 7.5% surgery; p=.72) [ 9 ].…”

“…Similarly, D’Agostino et al reported that in patients with initial GCS 3-5, simple wound closure patients had a higher incidence of mortality compared to surgical patients (72.2% versus 18.5%; p<.0001) [ 9 ]. The same paper also reported no differences in mortality between the two treatment groups for patients with initial GCS ≥6 (8.5% wound closure versus 7.5% surgery; p=.72) [ 9 ]. Helling et al noted a higher incidence of mortality for simple wound closure patients compared to surgery both in patients with initial GCS 3-4 (36/37, 97.3% versus 7/11, 63.6%; p<.0001) and in patients with initial GCS ≥5 (10/19, 52.6% versus 3/16, 18.8%; p=.007) [ 13 ].…”

“…Three studies reported the incidence of infection for patients treated with simple wound closure. First, D’Agostino et al clearly defined a central nervous system infection as an empyema, meningitis, ventriculitis, or cerebral abscess [ 9 ]. Infection rates were significantly less in the non-operative group compared to the operative group for patients with GCS 3-5 (6/158, 3.9% versus 14/122, 11.5%; p=.016), and for patients with GCS ≥6 (5/224, 2.2% versus 15/214, 7.0%; p=.017) [ 9 ].…”

“…First, D’Agostino et al clearly defined a central nervous system infection as an empyema, meningitis, ventriculitis, or cerebral abscess [ 9 ]. Infection rates were significantly less in the non-operative group compared to the operative group for patients with GCS 3-5 (6/158, 3.9% versus 14/122, 11.5%; p=.016), and for patients with GCS ≥6 (5/224, 2.2% versus 15/214, 7.0%; p=.017) [ 9 ]. Second, Kim et al reported no differences in the incidence of infection for patients treated with simple wound closure compared to operative intervention (0% versus 16.7%; p=.19) [ 16 ].…”