Surgical Management of Penetrating Intracranial Bullet Injuries

Sakr, Sameh; Azzazi, Alaa; Elsayed, Ahmed; Fathalla, Hussein

doi:10.1097/wnq.0000000000000120

Cited by 2 publications

(4 citation statements)

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“…One study reported self-inflected nail gun penetrating injury resulting in craniocerebral penetrating trauma [48]. One study reported TBI related to violence resulting in gunshot wounds to the head [49] and identified severe, moderate, and mild TBI (mTBI) present in 40, 10, and 50% of patients, respectively. Available adult assault data showed that compared to females, males were at higher risk for TBI due to violence/assault.…”

Section: Resultsmentioning

confidence: 99%

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Characterization of Traumatic Brain Injury Research in the Middle East and North Africa Region: A Systematic Review

et al. 2021

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Objectives: Traumatic brain injury (TBI) represents a major health concern worldwide with a large impact in the Middle East and North Africa (MENA) region as a consequence of protracted wars and conflicts that adversely affect the general population. Currently, systematic TBI studies in the MENA region are lacking, nonetheless they are immensely needed to enhance trauma management and increase survival rates among TBI patients. This systematic review aims to characterize TBI in the MENA region to guide future policy choices and research efforts and inform tailored guidelines capable of improving TBI management and patient treatment and outcome. Furthermore, it will serve as a road map to evaluate and assess knowledge of trauma impact on regional health systems that can be adopted by health-care providers to raise awareness and improve trauma care. Methods: We conducted a comprehensive search strategy of several databases including MEDLINE/Ovid, PubMed, Embase, Scopus, CINAHL, Google Scholar, and the grey literature in accordance with the PROSPERO systematic review protocol CRD42017058952. Abstracts were screened, and selected eligible studies were reviewed independently by 2 reviewers. We collected demographics information along with TBI characteristics, mortality rates, and regional distribution. Data were extracted using REDCap and checked for accuracy. Results: The search strategy yielded 23,385 citations; 147 studies met the eligibility criteria and were included in this review. Motor vehicle accident (MVA) was the leading cause of TBI (41%) in the MENA region, followed by the military- (15.6%) and fall- (8.8%) related TBI. Males predominantly suffer from TBI-related injuries (85%), with a high prevalence of MVA- and military-related TBI injuries. The TBI mortality rate was 12.9%. The leading causes of mortality were MVA (68%), military (20.5%), and assault (2.9%). The vast majority of reported TBI severity was mild (63.1%) compared to moderate (10.7%) and severe TBI (20.2%). Patients mainly underwent a Glasgow Coma Scale assessment (22.1%), followed by computed tomography scan (8.9%) and surgery (4.1%). Conclusions: Despite its clinical, social, and economic burden, the evidence of TBI research in the MENA region is scarce. Further research and high-quality epidemiological studies are urgently needed to gain a deep understanding of the TBI burden in the region, facilitate the allocation of adequate resources, implement effective preventive and intervention strategies and advise on the TBI patient management as reflective on the TBI patterns and modes.

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Section: Resultsmentioning

confidence: 99%

“…Available adult assault data showed that compared to females, males were at higher risk for TBI due to violence/assault. Nevertheless, assault-related TBI resulted in a substantial mortality rate ranging from 17 to 30% [42-44, 49].…”

Section: Resultsmentioning

confidence: 99%

Characterization of Traumatic Brain Injury Research in the Middle East and North Africa Region: A Systematic Review

et al. 2021

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“…The follow-up period ranged from 3 to 27 months. Seventy-four patients had undergone a surgical procedure, 9 including one or a combination of debridement, bullet extraction, hematoma evacuation, and/or decompressive craniotomy, while 28 patients had no surgical intervention (other than cleaning of wounds and simple suturing of a scalp wound). Those 28 patients had either one or more of the following scenarios: 1) one or more foreign objects from a blast injury, but of very tiny size and in deep and/or inaccessible locations, so we decided to leave them and only do simple skin debridement and closure; 2) a high risk of mortality and poor outcome, which discouraged us from operating on them; and 3) a traversing bullet or explosive fragment, with an inlet and exit (no retained foreign body) and no other surgical conditions.…”

Section: Study Populationmentioning

confidence: 99%

“…Moreover, in those whom we decide to treat, certain surgical and management controversies arise, such as indications of decompressive craniectomy, 3,7,11 bone reconstruction, 11 dural closure, 2,11 and indications to extract bullets. 2,8,9 The authors of this paper have a collective experience of treating more than 100 patients with military missile head injuries since 2010, managed in various war zone medical facilities. In this study, a retrospective review of these patients aided by guidelines from the literature has led to the identification of reliable predictors of mortality and poor outcome and thus assistance in deciding which patients to treat and how to treat them in the battlefield.…”

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confidence: 99%

Managing military penetrating brain injuries in the war zone: lessons learned

Fathalla¹,

Ashry²,

Fiki³

2018

Neurosurgical Focus

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OBJECTIVEManaging penetrating military brain injuries in a war zone setting is different than managing common civilian penetrating brain injuries. Triage, i.e., deciding on which patients to treat or not treat, and which to be flown back home, is essential to avoid wasting valuable limited resources. In this study the authors aim to identify reliable predictors of mortality and poor outcome to help develop a protocol for treating their patients in the battlefield. They also demonstrate all the lessons learned from their collective experience regarding some of the controversial management issues.METHODSThis study was a retrospective review of 102 patients with penetrating military missile head injuries treated by the authors in various facilities in northern Sinai between 2011 and 2018. Patient demographics, clinical characteristics, imaging characteristics, postoperative complications, and Glasgow Outcome Scale (GOS) scores were recorded for each patient. Several variables associated with mortality and poor outcome that were derived from the literature were analyzed, in addition to variables obtained by direct observation by the authors over time.RESULTSThere were 50 patients (49%) with GOS score of 1 (death), 12 patients (11.8%) with GOS score of 2 (survivors in persistent vegetative state), and 40 survivors (39.2%) with varying degrees of disability on the last follow-up evaluation. The authors identified an anatomical danger zone that was found to predict mortality when traversed. Bilateral dilated fixed pupils and low Glasgow Coma Scale score on admission were also found to be independent predictors of mortality and poor outcome. Based on these findings, a protocol was developed for managing these patients in the war zone.CONCLUSIONSManaging military penetrating head injuries in the war zone is different than civilian gunshot head injuries encountered by most neurosurgeons in urban cities. The authors developed a simple protocol for managing military penetrating injuries in the war zone. They also describe important lessons learned from this experience.

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Surgical Management of Penetrating Intracranial Bullet Injuries

Cited by 2 publications

References 10 publications

Characterization of Traumatic Brain Injury Research in the Middle East and North Africa Region: A Systematic Review

Characterization of Traumatic Brain Injury Research in the Middle East and North Africa Region: A Systematic Review

Managing military penetrating brain injuries in the war zone: lessons learned

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