Management of Craniocerebral Gunshot Injuries: A Review

Abstract

Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.

Prognostic Factors in Craniocerebral Gunshot Wounds: Analysis of 30 Patients from the Neurosurgical Viewpoint

“…[6] Open wounds with active bleeding and brain damage should be operated as soon as possible to save the life of the patient. [1,2,11,17] Aggressive surgical treatment is not helpful in patients with GCS score 3 and who have impaired brain stem functions. [17] Debridement of necrotic brain tissues and stopping the active bleedings are the main aims of the surgery.…”

“…Craniocerebral gunshot wounds (CGW) are increasing medical problems in a military setting, as well as in civilian practice. [1][2][3][4][5] Especially in recent years, the increasing incidents of violence, civil wars and terrorism in cities have made CGW even more important. [6][7][8][9] These injuries are the most lethal form of all firearm injuries, and the treatment principles are still controversial.…”

Management and Prognostic Factors of Penetrating Craniocerebral Wounds at One Teaching Hospital in Benin

“…The management of PCCW is a neurosurgical emergency [1] [31] [40]. This treatment is based on two mainstays: surgery and antibiotic therapy [7] [30] [41]. The condition of patients on admission may require a stay in the intensive care unit and stabilization of their hemodynamic or respiratory status prior to admission to the operating room [14] [28] [42].…”

Bullet fragments spontaneously migrating in opposite directions after a cardiac arrest treated with extracorporeal cardiopulmonary resuscitation following a gunshot wound to the head: A case report

“…Penetrating injuries due to GSWH have a poor prognosis and are fatal in most cases [ 5 ]. Rosenfield et al estimated that 66–90% of GSWH victims die before reaching the hospital [ 3 ].…”