Korean J Neurotrauma.  2015 Oct;11(2):35-43. 10.13004/kjnt.2015.11.2.35.

Management of Craniocerebral Gunshot Injuries: A Review

• Alvis-Miranda HR
• Adie Villafane R
• Rojas A
• Alcala-Cerra G
• Moscote-Salazar LR

• KMID: 2378256
• DOI: http://doi.org/10.13004/kjnt.2015.11.2.35

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.

Keyword

Brain injuries; Craniocerebral trauma; Wounds; Gunshot; Neurons

MeSH Terms

Arm
Brain
Brain Injuries
Cicatrix
Craniocerebral Trauma
Debridement
Decompression
Developing Countries
Foreign Bodies
Hemorrhage
Humans
Incidence
Military Personnel
Neuroimaging
Neurons
Quality of Life
Resuscitation
Scalp
Vital Signs
Wounds and Injuries

Figure

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  FIGURE 1 Simple brain computed tomography (CT) scan in a case of craniocerebral gunshot injuries. A: Multiple shrapnel from the left region to the right parieto-occipital region, accompanied by subdural hematoma, cerebral edema and ventricular collapse. B: CT bone window, right frontal fracture, accompanied by multiple intracranial shrapnel.

• 

  FIGURE 2 Management guideline for craniocerebral gunshot injury. Modified from Tsuei YS, Sun MH, Lee HD, Chiang MZ, Leu CH, Cheng WY, et al. Civilian gunshot wounds to the brain. J Chin Med Assoc 68:126-130, 2005.64) Copyright 2005 by the Elsevier. Reprinted with permission. GCS: Glasgow Coma Scale.

• 

  FIGURE 3 Adult male victim of craniocerebral gunshot injury (CGI) during assault. He was transferred promptly to our emergency service, received vigorous resuscitation despite Glasgow Coma Scale of 5 (E1V2M2) and emergent damage control neurosurgery. A: Image showing the inlet hole of CGI in left parietal region with perilesional tissue devitalization. B: Comminuted left skull associated to dural tear, brain laceration and bulging of macerated brain parenchyma. C: Postoperative image of subtotal left fronto-parietal lobectomy with drain of left intraparenchymal hemorrhage; hemisphere shows blunt damage and congestive feature. D: Suturing of operation site and inlet wound.

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