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2015 ; 11
(2
): 35-43
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Management of Craniocerebral Gunshot Injuries: A Review
#MMPMID27169063
Alvis-Miranda HR
; Adie Villafaņe R
; Rojas A
; Alcala-Cerra G
; Moscote-Salazar LR
Korean J Neurotrauma
2015[Oct]; 11
(2
): 35-43
PMID27169063
show ga
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.