BILATERAL DECOMPRESSIVE CRANIECTOMY IN A PATIENT WITH HEAD INJURIES DUE TO GUN PROJECTILE: A CASE REPORT
DOI:
https://doi.org/10.31157/an.v28i3.437Keywords:
decompressive craniectomy, gun projectile, penetrating trauma, traumatic brain injuryAbstract
A 38-year-old male patient with multiple skull injuries caused by a small-caliber firearm projectile whose entry hole was the right eye after being attacked when leaving his home. Consequently, he presented head trauma with multifragmented fracture of the cranial vault causing exposure of the brain mass in the bilateral frontoparietal region and complete injury to the right eyeball with fracture of the orbit in its posterior, lateral, medial, roof and floor walls. He was transferred to the General Hospital of Axapusco, where the patient was received with 8 points on the Glasgow scale and a simple tomography of the skull was performed, observing injury to both hemispheres, bilateral subarachnoid hemorrhage, parasagittal hemorrhagic contusions and cerebral edema, predominantly affecting to the corpus callosum and cingulum. Therefore, hinge-type decompressive craniectomy and debridement in the first 12 hours of trauma were determined as surgical treatment. It should be noted that a favorable recovery was obtained without associated complications. It is concluded that the surgical treatment of choice is early decompressive craniectomy when the patient presents less than 9 points on the Glasgow Coma Scale at admission, the injury along the path of the wound is bihemispheric and posterior fossa, the time that elapses from the injury to the performance of the surgery is within the first 12 hours, there is pupillary reactivity and the age of the patient is greater than 35 years.
References
Haoyi Qi, Kunzheng Li; Civilian gunshot wounds to the head: a case report, clinical management, and literature review; Chinese Neurosurgical Journal (2021) 7:12 https://doi.org/10.1186/s41016-020-00227-9 DOI: https://doi.org/10.1186/s41016-020-00227-9
Tunthanathip T, Udomwitthayaphiban S. Development and Validation of a Nomogram for Predicting the Mortality after Penetrating Traumatic Brain Injury. Bull Emergency Trauma. 2019;7(4):347-354. doi :10.29252/beat-070402. DOI: https://doi.org/10.29252/beat-070402
David J. Lin, Fred C. Lam, Jeffrey J. Siracuse , Ajith Thomas, Ekkehard M. Kasper; “Time is brain” the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes
Youssef Fahde , Mehdi Laghmari1, Mohamed Skoumi ; Penetrating head trauma: 03 rare cases and literature review; Pan African Medical Journal. 2017;28:305. doi:10.11604/pamj.2017.28.305.10376 DOI: https://doi.org/10.11604/pamj.2017.28.305.10376
Castillo-Rangel, C., , O. Salinas-Velázquez, , A. Gomez-Ibarra, G. Becerra-Escobedo, , V. H. Pérez Pérez, G. Marín-Márquez. "Report of an epicranial arteriovenous malformation." CESKA A SLOVENSKA NEUROLOGIE A NEUROCHIRURGIE 84.5 (2021): 488-490. DOI: https://doi.org/10.48095/cccsnn2021488
Castillo-Rangel C, Marín G, Hernandez-Contreras KA, Zarate-Calderon C, Vichi-Ramirez MM, Cortez-Saldias W, Rodriguez-Florido MA, Riley-Moguel ÁE, Pichardo O, Torres-Pineda O, Vega-Quesada HG, Lopez-Elizalde R, Ordoñez-Granja J, Alvarado-Martinez HH, Vega-Quesada LA, Aranda-Abreu GE. Atlas of Nervous System Vascular Malformations: A Systematic Review. Life. 2022; 12(8):1199. https://doi.org/10.3390/life12081199 DOI: https://doi.org/10.3390/life12081199
Peter J. Hutchinson, Angelos G. Kolias , Tamara Tajsic , Amos Adeleye , Abenezer Tirsit Aklilu ; Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury; Neurochirurgical Act (2019) 161:1261–1274 https://doi.org/10.1007/s00701-019-03936-y DOI: https://doi.org/10.1007/s00701-019-03936-y
Martins RS, Siqueira MG, Santos MT, Zanon-Collange N, Moraes OJ: Prognostic factors and treatment of penetrating gunshot wounds to the head. Surg Neurol 60:98–104, 2003 DOI: https://doi.org/10.1016/S0090-3019(03)00302-1
Gressot LV, Chamoun RB, Patel AJ, et al. Predictors of outcome in civilians with gunshot wounds to the head upon presentation: clinical article. J Neurosurg . 2014;121(3):645–52. https://doi.org/10.3171/2014.5.JNS131872 . DOI: https://doi.org/10.3171/2014.5.JNS131872
Qiu W, Guo C, Shen H, Chen K, Wen L, Huang H, et al. Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury. CritCare (2009) 13:R185. doi :10.1186/cc8178 DOI: https://doi.org/10.1186/cc8178
Grahm TW, Williams FC Jr, Harrington T, Spetzler RF: Civilian gunshot wounds to the head: a prospective study. Neurosurgery 27:696–700, 1990 DOI: https://doi.org/10.1227/00006123-199011000-00005
Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emerg Trauma Shock. 2011;4(3):395-402. doi:10.4103/0974-2700.83871 DOI: https://doi.org/10.4103/0974-2700.83871
Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. (2011) 364:1493–502. doi : 10.1056/NEJMoa1102077 DOI: https://doi.org/10.1056/NEJMoa1102077
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. (2016) 375:1119–30. doi : 10.1056/NEJMoa1605215 DOI: https://doi.org/10.1056/NEJMoa1605215
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September 2022-present © Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. No commercial re-use is allowed.
January-September 2022 © The authors. Open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. No commercial re-use is allowed.
January 2014-December 2021 © Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Open access articles under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
