Management and Surgical Outcome of Non Missile Penetrating Head Injuries at Assiut University Hospital: One Year Study

Abstract

Background: Non missile Penetrating head injury (NPHI) is head trauma in which an object other than bullets breaches the cranium and dura matter. Although NPHI is less common than missile penetrating injuries, it's management represent major challenge to health care providers in general and neurosurgeons particularly as impacted object (weapon) poses some technical difficulties in the investigation and management of the victims. Aim of the Study: Our study is based on analysis of clinical-radiological profile and outcome of patients of penetrating brain injuries. Patients and Methods: This is a prospective hospital based study includes 6 patients with non missile penetrating head injuries admitted and managed at department of neurosurgery and trauma units of Assiut university hospital through one year from march 2015 to march 2016. Results: The mean age was 17 years, and most patients were males. Most common clinical presentation was brain matter herniation with impacted object in victims skull in 5 (83.3%) patients followed by decreased level of consciousness in 4 (66.6%) patients. Fronto-Parietal lobe injury noted in 4 (66.6%) patients followed by temporal lobe in 2 (33.3%) patients. One patient died during the hospital stay. Patients discharged according to Glasgow outcome scale(GOS). Two patients were discharged in GOS-4 and three patients in GOS-5. Seizure developed in two (33.3%) patients. Conclusion: Non missile Penetrating head injuries are most common in children and adolescents and occur more commonly in male. Most common presentation was brain matter herniation or CSF leak. Fronto-Parietal and temporal lobar injury are the most common injury sites with higher mortality in temporal lobe injuries.