Craniocerebral Gunshot Injuries; A Review of the Current Literature
#MMPMID27331062
Alvis-Miranda HR
; M Rubiano A
; Agrawal A
; Rojas A
; Moscote-Salazar LR
; Satyarthee GD
; Calderon-Miranda WG
; Hernandez NE
; Zabaleta-Churio N
Bull Emerg Trauma
2016[Apr]; 4
(2
): 65-74
PMID27331062
show ga
Craniocerebral gunshot injuries (CGI) are increasingly encountered by
neurosurgeons in civilian and urban settings. Unfortunately, more prevalent
condition in developing countries, with major armed conflicts which is still
persisting, since the main trigger is violence at the national or state level.
Management goals of CGI should focus on aggressive resuscitation and correction
of coagulopathy; those with stable vital signs should undergo CT scan head at the
earliest possible opportunity. Neuroimaging is vital for planning of surgical
management, especially to determine the type of surgery, routes of the approach
to the surgical target area and extraction of the impacted foreign bodies,
however, surgical management is not always indicated. Although subset of such
cases may be managed even with non-surgical management. The treatment comprises
of immediate life salvaging resuscitative measures including control of the
persistent bleeding, care of associated injury, management of raised
intracranial pressure, prevention of cerebrospinal fistula formation by primary
watertight dural repair and prevention of infection, through extensive
debridement of contaminated, macerated or ischemic tissues; preservation of
nervous tissue and restoration of anatomic structures through the hermetic
sealing of dural and scalp defect. Recently, only few studies of craniocerebral
penetrating injuries are published that too involving smaller patients sample
sizes; although classic studies in the military and civil situation noticed
associated relatively very high mortality and morbidity and psychological as well
as economic impact on the affected individual, the family and the health system
in providing ongoing care to the sufferers and society at large. Currently
various measures are advocated with aim to reduce the incidence of CGI especially
in civilian populations. It is highly necessary and immensely urgent to promote
research in a neurocritical care of CGI to provide positive impact on improvement
of the quality of life and further providing better care and reduction of
overall health care cost.
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