Cranial Gravitational (Falling) Bullet Injuries: Point of View

The role of strict patient-positioning during nursing in the management of intracerebral migration of gravitational bullet injury

“…Although Rapp et al [14] and Taarnhoj [28] document using this positioning technique for penetrating bullet injury in general, our clinical experience suggests using this technique in gravitiational (falling) bullet injury will be more fruitful taking in consideration multiple factors that are unique for the falling bullets. The gravitiational (falling) bullets are usually non-fragmented, not very small nor too large, smooth outer contour and with less adhesive surrounding brain tissue (less cavitation and necrosis as compared to other types of penetrating bullet injuries), these factors make this falling bullets are more liable for migration and also more amenable to be affected and guided by the patient positioning during the early observation period (Figure 1 shows an illustrative case scenario for the mentioned technique).…”

“…Although activity restriction is part of the general practice during this observation period, some surgeons suggest a more strict head positioning during the nursing period and consider it as pivotal part of the management of such instances [14,28].…”

“…Both Rapp et al [14] and Taarnhoj [28] describe in their reports that they use the strict patient positioning during nursing in few cases, the aim of this positioning is an attempt to change or control the direction of bullet migration in migrationpossible cases. In our practice, we routinely implement this strict-positioning technique to render a deep bullet with possible migration to an accessible and easy to remove one.…”

“…The literature is still away from delivering a clear guideline and constitutes more of case reports rather than comprehensive well-designed studies [2][3][4][5][6][7][8][9][10][11][12][13], this mostly due to the variability and diversity in the presentation and management of such cases. The migration of bullet can be a sequel of any type of penetrating injury to the skull [14]. Intracranial migration after gravitational (falling) bullet injury is a unique type of injury that constitutes of significant human and material losses with differences in biomechanics and structural brain changes after the insult especially regarding the velocity of impact and the degree of yaw for the intracranially settled bullet [15].…”

PubMed-indexed neurosurgical research productivity of Iraq-based neurosurgeons

“…Over the past few decades, the population demands for neurosurgical care has increased enormously, in conjunction with the ongoing war and armed conflict in the region. is review was designed with the following questions in mind: (1) what is the current status of neurosurgery publications from Iraq? (2) What are the current trends?…”