Surgical management of civilian gunshot wounds to the head

Aarabi, Bizhan; Mossop, Corey; Aarabi, Judith Ann

doi:10.1016/b978-0-444-52892-6.00012-x

Cited by 46 publications

(24 citation statements)

References 98 publications

(146 reference statements)

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“…The results of this more conservative approach were shown to be equivalent to earlier approaches and this conservative trend has persisted during more recent conflicts. [4][5][6]12 Although our data is different to these military reports as the penetrating trauma is mostly of low velocity trauma, our results are very much in keeping with this trend towards conservatism. Only in patients with axe wounds to the head was surgery needed in more that 60% of cases.…”

Section: Discussionsupporting

confidence: 56%

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

et al. 2019

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Background: This study reviews our experience with penetrating Traumatic Brain Injury (TBI) in order to define and describe the injury pattern and the outcome. A secondary aim of this study was to review the use of the Motor Score (M Score) and the Simplified Motor Score (SMS) to assess and triage patients with penetrating TBI. Methods: All patients with a TBI secondary to a penetrating mechanism were identified from the Hybrid Electronic Medical Registry at Pietermaritzburg Metropolitan Trauma Service (PMTS) from January 2012 to December 2014. Standard demographic data, need for neuro-surgical intervention, location of external wounds, CT findings and mortality where analysed. The Glasgow Coma Scale (GCS) M score and SMS score were specifically evaluated to determine the relationship between the individual motor component and patient outcome. Results: Over the two-year period January 2012-December 2014, a total of 384 patients were admitted following a penetrating TBI. There were 350 males and 34 females and of this total 7 (1.82%) died. The mechanism of injury was axe (30), bottle (34), gunshot wound (GSW) (22) and stab wound (298). The average age for axe injuries was 27 and bottle injuries was 30. The average age for firearms and knives was 29 and 30 respectively. Surgery was not required for 76.67% of patients. The need for surgery varied according to mechanism of injury. Axe injuries were treated non-operatively in 47.83%, bottle injuries in 87.50%, firearms 70% and knife injuries were treated nonoperatively in 86.84% of cases. The overall survival rate for a penetrating head injury in this population is 98.16%. There were a total of 368 patients with a motor score of 6 of which one died. The survival rate was 99.7% and the mortality rate 0.3%. There were only 6 patients with a motor score of 5 and only 2 with a motor score of 4. The survival rate for both these groups was 100%. There was a total of 6 patients with a motor score of 1. There was a 100% mortality rate is this group. Conclusion: Penetrating TBI has a good prognosis. The vast majority of cases do not require neuro-surgical intervention. Poor motor score is associated with a poor outcome.

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Section: Discussionsupporting

confidence: 56%

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

et al. 2019

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“…38 Although not supported by any prospective randomized controlled study, the use of prophylactic broad spectrum antibiotics is appropriate for patients with PBI since these wounds are considered to be contaminated. 39 According to the current US military guidelines, patients should receive cefazolin for 5-7 days. 40 Helling et al stated that antibiotics, usually cephalosporins for blood-brain barrier penetration, were routinely administered to all patients, and no instances of postoperative brain abscesses were reported.…”

Section: Clinical Managementmentioning

confidence: 99%

“…The implanted material along with necrotic brain and bone fragments are usually at the entrance of the incurred brain wound and if not well debrided can act as a nidus for infection. 39 Among the dreadful complications of GWH are CSF leaks or stulas, which have been variably reported in from 0.63 to 8.9% of patients. They are more frequent in patients with ventricular involvement and incomplete dural and scalp closure, the chance of infection was increased 20 times in patients with CSF stulas.…”

Section: Complicationsmentioning

confidence: 99%

Civilian Gunshot Wounds to The Head: A Case Report, Clinical Management, and Literature Review.

2020

Preprint

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Background: Civilian Gunshot wounds to the head refers to the brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives, gunpowder, etc. as a power launch or explosion. Gunshot wounds to the head is the deadliest of all gun injuries, according to literature statistics, the survival rate is only 9%.1 Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost based on military experience, and there are few related reports especially the head suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffered shots on the head twice in a short period of time.Case Presentations: We present a case of a 53-year old male who suffered twice gunshot injuries to the head under unknown circumstances. On initial presentation the patient had a Glasgow Coma Score of 6, unable to communicate, loss of consciousness. The first bullet penetrated from the right frontal area and finally reached the right occipital lobe. When the patient subconsciously covers his head with his hand, the second bullet through the patient's right palm bone, entered from the right frontotemporal, and stayed deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital, and immediately entered the operating room for rescue after a compute tomography scan. After two foreign body removals and one skull repair, the patient recovered completely.Conclusions: Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital followed by proactive treatment against infection, seizure and increased intracranial pressure. Surgical intervention is usually necessary, and its key point usually includes the timing of the operation, the method of operation, and the scope of the operation.

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“…Fifty percent of all trauma-related deaths are attributed to traumatic brain injury with 35% of these injuries resulting from gunshot wounds to the head [1-2]. This accounts for approximately 20,000 injuries [3-4]. Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication.…”

Section: Introductionmentioning

confidence: 99%

A Unique Presentation of an Intracranial Abscess Secondary to Retained Projectile after Debridement with Dural Closure

Milton

Awuor

2017

Cureus

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Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication. The most common presentation is a suddenly worsening headache. The most common pathogen identified is staphylococcus. Outcomes are related to adherence of Matson’s tenets.This case study details the presentation of a 19-year-old patient that presented to the neurological surgery clinic without neurologic deficits. Further questioning revealed complaints of intermittent diffuse headaches with bilateral upper extremity shock-like sensation for two weeks. Eight weeks prior he had undergone right craniotomy, after a gunshot wound, for debridement and watertight dural closure. The patient denied symptoms of fever, chills, nausea, vomiting, diarrhea, or seizure. The patient presented with a noncontrast head computed tomography (CT) which revealed retained projectile fragments without clear evidence of abscess. On physical exam, the patient was without any neurological deficit. Laboratory investigation revealed normal white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and negative blood cultures. Head CT with contrast revealed a large intracerebral abscess adjacent to the thalamus. The patient was taken to the operating room for repeat craniotomy with resection of the abscess and removal of the intracranial projectile fragments.Post-operatively, the patient remained neurology intact. Intraoperative cultures were not significant for the growth of any bacteria. In eight weeks time, the patient returned to his employment and his baseline level of activity.This case underscores the importance of thorough assessment in patients with retained intracranial projectiles as well as the need to routine follow-up. The unique presentation of this patient prompted further investigation which elucidated a lesion which correlated to his symptoms although laboratory assessment was without abnormality.

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Surgical management of civilian gunshot wounds to the head

Cited by 46 publications

References 98 publications

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

Civilian Gunshot Wounds to The Head: A Case Report, Clinical Management, and Literature Review.

A Unique Presentation of an Intracranial Abscess Secondary to Retained Projectile after Debridement with Dural Closure

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