Civilian gunshot wounds to the head

Grahm, Thomas W.; Williams, Fred C.; Harrington, Timothy; Spetzler, Robert F.

doi:10.1097/00006123-199011000-00005

Cited by 59 publications

(20 citation statements)

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“…On the other hand, all patients with a GCS score > 5 should receive aggressive surgical therapy. [7] More recent studies have recommended aggressive surgical management in patients with GCS scores ≥ 8. [614] Our results differ greatly from those reported by Clark et al ., as 3 out of 4 of our patients had a GSC of 3, received emergent surgical decompression and survived.…”

Section: Discussionmentioning

confidence: 99%

"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

Lin

Lam²,

Siracuse³

et al. 2012

Surg Neurol Int

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Background:Review of intracranial gunshot wounds (GSWs) undergoing emergent neurosurgical intervention despite a very low Glasgow Coma Scale (GCS) score on admission in order to identify predictors of good outcome, with correlates to recent literature.Methods:A retrospective review of select cases of GSWs presenting to our trauma center over the past 5 years with poor GCS requiring emergent neurosurgical intervention and a minimum of 1-year follow-up.Results:Out of a total of 17 patients who went to the operating room (OR) for GSW to the head during this period, 4 cases with a GCS < 5 on admission were identified. All cases required a hemicraniectomy to alleviate cerebral swelling. Two cases presented with a unilaterally blown pupil due to raised intracranial pressure. The remaining 2 cases had equal and reactive pupils. One patient with a GCS of 3 and a significant bilateral pattern of parenchymal bullet injury was initially assessed in moribund status but rallied and received a delayed hemicraniectomy on day 7. Three out of 4 patients are functionally independent at 1-year follow-up. The fourth patient who received a delayed decompression remains wheelchair dependent.Conclusion:Victims of GSWs can have good outcomes despite having a very poor admission GCS score and papillary abnormalities. Factors predicting good outcomes include the following: time from injury to surgical intervention of < 1 h; injury to noneloquent brain; and absence of injury to midbrain, brainstem, and major vessels.

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Section: Discussionmentioning

confidence: 99%

"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

Lin

Lam²,

Siracuse³

et al. 2012

Surg Neurol Int

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“…Early and adequate surgical debridement of the necrotic tissue reduces both the incidence of elevated intracranial pressure and the rate of infection [9]. Intracranial infections are a feared complication of penetrating missile injuries to the brain.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the outcomes of retrospective studies from early military and more recent civilian series, physicians have assumed that patients who have sustained a gunshot to the head resulting in a transventricular injury, an injury that crosses the midline, or a low admitting Glasgow Coma Scale score have a poor prognosis. Violence, commonly involving gunshot wounds, particularly gunshot wounds to the head, is a major and worsening public health problem [9, 12]. …”

Section: Discussionmentioning

confidence: 99%

Spontaneous Movement of Bullets in the Interhemispheric Region

Karabağlı¹

2005

Pediatr Neurosurg

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Gunshot wounds to the head are usually mortal injuries. Their frequency has been increasing in the last years because of increasing crime and war rates. Penetrating craniocerebral injury in children and adolescents at the age of 17 or under is an increasing cause of emergent neurosurgical admissions to major metropolitan medical centers. I report a patient in whom a bullet in the brain moved from the interhemispheric region to 1 cm to the left of the inner occipital protuberance and midline. The patient recovered from surgery uneventfully. He was followed up for 4 years without neurodeficits. Spontaneous movement of bullets within the brain has been reported sporadically. The removal of intracerebral bullets is obviously warranted in patients undergoing craniotomy or craniectomy for debridement or evacuation of intracerebral clots or bone fragments if the metallic fragment is in proximity to the operative site. Before surgical removal of any intracerebral bullet, it is recommended that an intraoperative plain skull X-ray be obtained after final positioning of the head.

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“…Overall, 90% of civilian GSWs are lethal [1]. Principles to guide treatment of GSWs are outlined by Grahm (Table 1) and Matson (Table 2) [2-3]. …”

Section: Introductionmentioning

confidence: 99%

A Case-Based Review of the Management of Penetrating Brain Trauma

Milton

Rugino

Narayan

et al. 2017

Cureus

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Principles of penetrating head trauma management were established by Harvey Cushing in relation to the management of penetrating brain injuries of World War One. Cushing radically debrided the scalp and skull and aggressively irrigated wound tracks to remove foreign bodies. He would then obtain water-tight closure. Cushing significantly decreased infection rates which reportedly limited the major cause of mortality due to penetrating head injuries. Many advances have been made by contributions from World War Two, Korean War, Vietnam War, and Iran/Iraq conflicts. Early radical decompression, with conservative debridement and duraplasty applied to blast-induced penetrating injuries during Operation Iraqi Freedom, has resulted in increased survivability and neurological improvement. Each advance in the management of these injuries is based upon more effectively addressing one or more components of Matson’s tenets.This case series reviews the successful management of three patients that presented to a level I trauma center with a penetrating head injury from high-velocity projectiles. Management principles of each patient begin with a proper patient assessment, application of Matson’s tenets from the time of injury, and airway control. Surgical management is based upon adherence to Grahm’s Guidelines which emphasize criteria centered upon post-resuscitative Glasgow Coma Scale score and appropriate imaging.This case series suggests that proper patient evaluation, adherence to Matson’s tenets and to Grahm’s Guidelines, and appropriate patient selection for operative management leads to improved survival of patients with penetrating head trauma from high-velocity projectiles.

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Civilian gunshot wounds to the head

Cited by 59 publications

References 0 publications

"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

Spontaneous Movement of Bullets in the Interhemispheric Region

A Case-Based Review of the Management of Penetrating Brain Trauma

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