Endoscopically Assisted Retrieval of an Intracranial Air Gun Pellet

Mohanty, Aaron; Manwaring, Kim H.

doi:10.1159/000065104

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…[39] Also with stereotactic guidance, deep-seated intraparenchymal lesions can be satisfactorily approached and removed endoscopically. [31]…”

Section: Discussionmentioning

confidence: 99%

Image guided surgery in the management of craniocerebral gunshot injuries

Elserry¹,

Anwer²

2013

Surg Neurol Int

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Background:A craniocerebral trauma caused by firearms is a complex injury with high morbidity and mortality. One of the most intriguing and controversial part in their management in salvageable patients is the decision to remove the bullet/pellet. A bullet is foreign to the brain and, in principle, should be removed. Surgical options for bullet extraction span from conventional craniotomy, through C-arm-guided surgery to minimally invasive frame or frameless stereotaxy. But what is the best surgical option?Methods:We prospectively followed up a cohort of 28 patients with cranio-cerebral gunshot injury (CCHSI) managed from January to December 2012 in our department of neurosurgery. The missiles were extracted via stereotaxy (frame or frameless), C-arm-guided, or free-hand-based surgery. Cases managed conservatively were excluded. The Glasgow Outcome Score was used to assess the functional outcome on discharge.Results:Five of the eight “stereotactic cases” had an excellent outcome after missile extraction while the initially planned stereotaxy missed locating the missile in three cases and were thus subjected to free hand craniotomy. Excellent outcome was obtained in five of the nine “neuronavigation cases, five of the eight cases for free hand surgery based on the bony landmarks, and five of the six C-arm-based surgery.Conclusion:Conventional craniotomy isn’t indicated in the extraction of isolated, retained, intracranial firearm missiles in civilian injury but could be useful when the missile is incorporated within a surgical lesion. Stereotactic surgery could be useful for bullet extraction, though with limited precision in identifying small pellets because of their small sizes, thus exposing patients to same risk of brain insult when retrieving a missile by conventional surgery. Because of its availability, C-arm-guided surgery continues to be of much benefit, especially in emergency situations. We recommend an extensive long-term study of these treatment modalities for CCGSI.

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“…[39] Also with stereotactic guidance, deep-seated intraparenchymal lesions can be satisfactorily approached and removed endoscopically. [31]…”

Section: Discussionmentioning

confidence: 99%

Image guided surgery in the management of craniocerebral gunshot injuries

Elserry¹,

Anwer²

2013

Surg Neurol Int

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“…[6161721–25] Since 2004, endoscopic transnasal removal of intracranial foreign bodies has been reported. [820]…”

Section: Discussionmentioning

confidence: 99%

“…[68161720–25] To our knowledge, intracranial bullet extraction through an endoscopic transnasal craniectomy (ETC) has never been reported before, which is also related to the low frequency of favorable positioning of the bullet and to the high mortality rate. This report details the operative technique for a unilateral keyhole craniectomy of the anterior skull base with subsequent multilayer reconstruction.…”

Section: Introductionmentioning

confidence: 99%

Intracerebral bullet removal through an endoscopic transnasal craniectomy

Villaret

Zenga²,

Esposito³

et al. 2012

Surg Neurol Int

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Background:In the past decade, the endoscopic transnasal technique has been broadly applied as a feasible and less invasive approach to the skull base. The adaptability of the endoscopic technique allows a case-specific approach in order to minimize both endonasal and cranio-cerebral manipulation; therefore it can be also used in patients complaining exceptional skull base lesions and in weak patients. The objective of this paper is to present the first case of intracerebral bullet removal using a pure endoscopic transnasal route through a custom made unilateral craniectomy.Case Description:A 59-year-old patient was admitted to the emergency department after a gunshot injury to the head, thorax, abdomen, and pelvis. Admission Glasgow Coma Scale was 7. Brain computed tomography (CT) scan highlighted a right occipital hole defect due to perforative impact, intracerebral dislocations of bone fragments, right intracerebral and subdural hematoma, and midline shift to the left side; the bullet was localized in the right frontal lobe and its tip was in contact with the ethmoid roof.The patient underwent emergency decompressive craniectomy and evacuation of the subdural hematoma and abdominal explorative laparotomy, ileum resection, and gastrorrhaphy. After 1 month, the patient underwent endoscopic transnasal removal of the bullet and skull base reconstruction due to cerebrospinal fluid infection. The postoperative course was uneventful and he has done well in follow-up with no evidence of cerebrospinal fluid leak and preservation of olfaction.Conclusion:The adaptability of the endoscopic transnasal technique offers patients complaining exceptional skull base lesions a case-specific strategy minimizing morbidity and postoperative stay.

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“…10,11 To date there are few reports describing retrieval of intracranial foreign bodies using an endoscopic approach. 12,13 In a case presented by Mohanty and Manwaring, 13 an air gun pellet entered the brain through the left forehead region and lodged in the left frontal lobe. A frontal craniotomy was performed to allow removal of intraparenchymal bone fragments.…”

Section: Commentmentioning

confidence: 99%