Bilateral Decompressive Craniectomy in a Patient With Head Injuries Due to Gun Projectile: A Case Report

Abstract

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.