Analysis of 2187 consecutive penetrating wounds of the brain from Vietnam

Hammon, William McD.

doi:10.3171/jns.1971.34.2part1.0127

Cited by 180 publications

(64 citation statements)

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“…Hammon 36 recounted his series of 2187 patients with head injuries and described this successful implementation of the evacuation and early neurosurgery model. Of the patients who underwent surgery in his series, 95% were evacuated by helicopter and treated early with establishment of an airway, resuscitative fluids, and a sterile head dressing.…”

Section: Vietnam Warmentioning

confidence: 99%

An historical context of modern principles in the management of intracranial injury from projectiles

Agarwalla

Dunn

Laws

2010

FOC

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The contemporary management of projectile head injuries owes much to the lessons neurosurgeons have distilled from their experiences in war. Through early investigation and an increasingly detailed account of wartime clinical experience, neurosurgeons-including the field's early giants-began to gain a greater understanding not only of intracranial missile pathophysiology but also of appropriate management. In this paper, the authors trace the development of the principles of managing intracranial projectile injury from the Crimean War in the 19th century through the Vietnam War to provide a context that frames a summary of today's core management principles.

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Section: Vietnam Warmentioning

confidence: 99%

An historical context of modern principles in the management of intracranial injury from projectiles

Agarwalla

Dunn

Laws

2010

FOC

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“…26) In such cases, early and deep debridement of devitalized brain tissue and removal of all accessible foreign bodies and bony fragments is also advocated. 5,9,17,21,27,30,38) The present study suggests that deep and maximal debridement of devitalized brain tissue and removal of all accessible foreign bodies and bony fragments must be performed as aggressively and early as possible to prevent the resultant edema associated with devitalized brain tissue. An indriven foreign body or large amounts of necrotic brain tissue is generally considered to be an important source for epileptic seizures and increased infection rate.…”

Section: Discussionmentioning

confidence: 99%

“…17) Recently, the suggested treatment for missile or shrapnel head wounds has been divided into four groups: Large craniotomy or craniectomy and aggressive deep debridement, no surgical operation, minimal or superficial debridement, and simple debridement of the entrance gutter through a small craniotomy. 6,10,15,33,40) There is no consensus about the surgical indications or aggressiveness because of the great number of variables to be considered, such as the number and distribution of fragments, the occurrence of different types of lesions caused by different types of missiles and shrapnel particles, and the involvement of eloquent areas.…”

Section: Discussionmentioning

confidence: 99%

“…In later wars, especially the World War II and Korean War, more aggressive surgery with deep debridement of necrotized brain tissue and bony fragments was shown to decrease infection and mortality. 17,18) The mortality ranges from 23% to 92% and is markedly higher at 87-100% in patients admitted with poor neurological status. 3,4,8,11,13,16,19,22,23,25,29,34,35,37,39) Many other factors have been associated with mortality including hemodynamic and respiratory status at admission, missile type, pupil diameter and reactivity, and computed tomography (CT) findings.…”

Section: Introductionmentioning

confidence: 99%

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High-Velocity Gunshot Wounds to the Head: Analysis of 135 Patients

Bakir

Temız

Umur

et al. 2005

Neurol. Med. Chir.(Tokyo)

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Head injuries due to high-velocity missiles and shrapnel as a result of military conflicts have become a very important cause of death or severe neurological deficits. Military-type missiles have high velocities and transfer higher amounts of energy to neural tissue, compared to civil-type missiles. This physical phenomenon also causes greater neural tissue destruction. Shrapnel particles derive from blasts and cause less severe injury because of the irregular particle shape and low energy transmission. This study analyzed 135 patients with head trauma, 80 patients (59%) injured by missiles and 55 patients (41%) by shrapnel. Glasgow Coma Scale (GCS) scores at admission were 3 to 7 in 69 patients, 8 to 10 in 29 patients, and 11 to 15 in 37 patients. The most common anatomical localizations were the right frontoparietal region in 42 patients and the left frontoparietal region in 40 patients. One hundred patients (74%) were operated on immediately and 35 patients (26%) were treated conservatively in the intensive care unit. Ten of the 135 patients died (7.4%), seven from missile injury and three from shrapnel injury. In this study, we found that high mortality was associated with low GCS score at admission, presence of multilobar or skull base injuries, and involvement of ventricles. Early and aggressive surgical intervention decreased the mortality.

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“…Those of middle and anterior location are especially dangerous 2,9,10,14,18 . Most of them are due to the negligence of the security rules established for underwater fishing 6 .…”

Section: Introductionmentioning

confidence: 99%

Perforating brain injury from a speargun. A case report

et al. 2011

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SummaryA case of a perforating brain injury caused by a speargun in a suicide attempt is described. Although this kind of injuries has been previously reported, the present case is specially interesting because the patient showed no neurological deficit after surgery. Some advices about the medical and surgical management are proposed based on this case and our literature review. The use of antibiotics and antiepileptic drugs and the anterograde extraction of the harpoon aided by the performance of a craniotomy surrounding the exit point are recommended.KEY WORDS. Speargun. Perforating injury. Cranial trauma.Traumatismo craneal perforante por arpón de pesca. A propósito de un caso Resumen Describimos un caso de traumatismo craneo-encefá-lico perforante causado por un arpón de pesca submarina tras intento de autolisis. Aunque traumatismos parecidos han sido publicados previamente, el presente caso es especialmente interesante dada la escasa repercusión neurológica que el paciente presentó tras la cirugia. Basándonos en esta experiencia y en nuestra revisión bibliográfica proponemos algunos consejos que pueden ser de utilidad en el manejo médico y quirúrgico. El uso de antibióticos y antiepilépticos así como la extracción anterógrada del arpón con la ayuda de una craneotomía rodeando su punto de salida son algunas de estas recomendaciones.PALABRAS CLAVE. Arpón. Traumatismo perforante. Traumatismo craneal.

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Analysis of 2187 consecutive penetrating wounds of the brain from Vietnam

Cited by 180 publications

References 0 publications

An historical context of modern principles in the management of intracranial injury from projectiles

An historical context of modern principles in the management of intracranial injury from projectiles

High-Velocity Gunshot Wounds to the Head: Analysis of 135 Patients

Perforating brain injury from a speargun. A case report

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