Neurosurgical Care of Nonpowder Firearm Injuries: A Narrative Review of the Literature

Abstract

Background. Nonpowder firearms discharge a projectile using compressed gases. Unlike traditional firearms, there is a perception that nonpowder guns do not cause serious injury. However, intracranial injury disproportionally affects children and can cause significant neurological disabilities and mortality. Management of nonpowder firearm injuries has received little attention in the literature and presents unique surgical challenges. Materials and Methods. We conducted a narrative review of the literature of the management of nonpowder firearm injuries with particular emphasis on intracranial injury. Results. Modern nonpowder firearms have muzzle velocities which are capable of penetrating the skin, eyes, and bone. Direct intracranial injury commonly results from entrance of projectile through thinner portions of the skull. Operative intervention is needed to debride and safely explore the trajectory to remove fragments which can easily cause neurovascular injury. Conclusions. Neurosurgeons play a crucial role in managing serious nonpowder firearm injuries. A multidisciplinary team is needed to manage the direct results of penetrating injury and long-term sequalae.

Surviving the Scene in Civilian Penetrating Brain Injury: Injury Type, Cause and Outcome in a Consecutive Patient Series in Austria

“…In total, 40% (6/15) of patients in our series developed seizures during their course. The onset is in line with the published data, although very few reports exist ( 29 , 31 – 33 ). Shaw reported seizure onset below 10% within the first two weeks but a significant rise within two years ( 32 ).…”

“…The bilateral penetrating trajectory was also significantly more common in HVI, reflecting the nature of firearm injuries with subsequent worse outcomes. CT angiography in the urgent setting is of great importance to assess possible vascular injury and a low threshold for angiography at diagnosis is proposed ( 29 ). Also, in the long term, CT angiography is useful in detecting vascular injuries such as pseudoaneurysms, carotid-cavernous fistulas, or dural arteriovenous fistulas.…”

“…Interestingly, all seizures could easily be controlled with a single antiepileptic medication. Awareness of seizures is also important in the long term ( 31 , 33 ), and some neurosurgeons propose prophylactic antiepileptic medications for 7 days in all patients with PBI ( 29 ).…”

Early and Ultraearly Administration of Tranexamic Acid in Traumatic Brain Injury: Our 8-Year-Long Clinical Experience

“…Our study group is small-sized and gunshot wounds were seen in only two patients. But gunshot wounds are known for their devastating consequences in terms of profuse intracranial bleeding; hence, TXA can be useful [ 16 ].…”

Clinical Significance of Isolated Third Cranial Nerve Palsy in Traumatic Brain Injury: A Detailed Description of Four Different Mechanisms of Injury through the Analysis of Our Case Series and Review of the Literature

“…During the terminal stage of herniation, where the medulla is affected, the diffuse hypoxia continues to sustain mydriasis; therefore, the damage becomes irreversible. Fixed dilated pupils have thus historically been associated with a very poor prognosis in TBI [11][12][13][14][15].…”