Management and Prognostic Factors of Penetrating Craniocerebral Wounds at One Teaching Hospital in Benin

Abstract

Introduction. Penetrating craniocerebral wounds (PCCWs) are a particular lesion in the category of traumatic brain injury (TBI). The objective of this study was to describe the management of these lesions, and to identify signifiant risk factors associated with mortality in patients with a PCCW. Methods. It was a transversal, descriptive and analytical study performed in Departmental Teaching Hospital of Borgou and Alibori in Benin. From January 1, 2015 to June 30, 2020, patients with a PCCW were retained. Risk factors of mortality and morbidity associated to etiological, clinical and surgical parameters were assessed using the chi-square test. p value < 0.05 was considered to be statistically significant. Results. During the study period, 1267 cases of traumatic brain injuries (TBI) were admitted. Of these patients, 77 (6.1%) cases of PCCW were retained. These patients were divided into 66 (85.7%) male and 11 (14.3%) female. The mean age of the patients was 22.6 ± 14.8 years (range from 2 years to 70 years). The circumstances of occurrence were a traffic accident in 42 (54.5%) cases, an assault in 33 cases (42.9%) and a fall 2 (2.6%). The PCCW was unilateral in 71 cases (92.2%). A brain CT-scan was performed in 60 (77.9%) patients. Surgery was performed in 69 (89.6%) patients. Post-operative outcomes were simple in 59 (85.5%) cases. GCS, pupillary abnormalities, motor deficit were a statistically significant risk factor associated with death or sequels (p < 0.0001). Conclusion. The identification of risk factors of mortality or sequels is a major step for an efficient management of PCCWs and a reduction of morbidity and mortality. Whatever strategies are adopted, prevention must remain a priority.

Particular Surgical Technique for Transorbital—Penetrating Craniocerebral Injury Inflicted by a Screwdriver: Technical Case Report

“…In many cases, patients often exhibit symptoms due to injuries or complications from direct impact or surgery, depending on which area is involved. 1 6 11) Several factors such as the depth of the puncture >50 mm, vascular injury, and the involvement of the eloquent area can give a poor outcome, where a study conducted by Harrington obtained a mortality of 10%. 4) Vascular injury is one of the complications of PBI, which ranges from 4%–50% of reported cases.…”

“…Penetrating brain injury (PBI) is a part of brain injury that has a worse prognosis compared to blunt brain injury. 5 6) Surgical techniques in PBI are generally challenging to perform because they require good preoperative planning. 11 18 19) In addition, there are many variations and modifications of surgical techniques used to facilitate the extraction of foreign bodies.…”