The Radiologic Evaluation of Craniocerebral Missile Injuries

Intraoperative navigation assisted reconstruction of a maxillo-facial gunshot wound

INTRODUCTION

This case report describes a suicidal gunshot wound to the head using a handgun (9 x 19 mm). During mandibular penetration, the solid hollow point projectile (Aktion4) was deformed but did not fragment. The mandible, mid-face, orbit, and nasal complex were severely damaged. Here, the authors present, for the first time, a new approach for bilateral mid-facial fractures.

MATERIALS AND METHODS

For virtual reconstruction, a naso-orbito-ethmoidal complex of an unaffected skull (same age, sex, and ethnic group) was merged into the computed tomography (CT) data set. Based on this data set, a navigation assisted operation was performed.

CONCLUSION

The favorable outcome leads us to recommend the technique of merging comparable CT data for reconstructive planning of bilateral mid-facial fractures.

Care of the critically ill patient with penetrating head injury

Patients who have penetrating head injury all too often present with some of the most devastating and challenging intracranial injuries. The mechanisms of injury and associated neuropathology affect every body system and require a multidisciplinary approach. Evidence-based guidelines have been developed to offer some direction to clinicians involved in their care. Much remains scientifically unsubstantiated, however. Optimal management of critically ill patients who have penetrating head injury requires clinical expertise and care of the highest quality.

A different approach to missile induced head injuries

Missile induced head injuries can be influenced by the anatomical location of the injury, i.e. type of tissue and by the ballistic properties such as the design of the weapon and the mass, shape and construction of the projectile, as well as its velocity characteristics and trajectory angle. In the diagnostic work up of the patients with missile induced head injuries, every available modality can be used. It is important, however, to recognize that CT scan is the primary and most efficacious diagnostic tool in such patients. In this article we have identified risk factors for both morbidity and mortality in patients with missile induced head injury with excluding the patients who had also extracranial serious trauma and systemic disease.

On-the-field evaluation of an athlete with a head or neck injury

Head and cervical spine sports-related injuries are intimately associated. The on-field evaluation and management of the athlete with these injuries is of paramount importance to stabilize the athlete and prevent further injury. Clinicians need to be aware of the differential diagnoses and consider each possibility based on the mechanism of injury. Although recognition of head and cervical spine injuries has resulted in significant reductions of catastrophic neurological injuries, especially in the cervical spine, further advances to decrease the incidence and long-term sequelae of head and neck injuries are needed. The first step is education of the athlete and the individuals involved in the care of that athlete.

Penetrating craniocerebral injuries in a civilian population in mid-Europe

Our current neurosurgical understanding of civilian penetrating craniocerebral injuries is based on US metropolitan series. It is unknown whether all principles applied to these patients are relevant in the Mid-European setting with its distinct epidemiology. The objective of this study was to characterize our patients with penetrating craniocerebral injuries, to analyze their outcome, and to identify relevant prognostic factors. Thirty-two patients with penetrating craniocerebral injuries were entered into the study. Patient evaluation comprised neurological, laboratory and radiographic analyses. Motivating factors were suicide (75%), assault (13%), and accident (9%). Initial GCS score, coagulopathy on admission, and radiographic extent of injury could be identified as outcome predictors (P < 0.001). An aggressive therapeutic approach to patients with GCS 3-7 reduced mortality when compared to a conservative management (67 vs. 91%). Due to major differences in epidemiology and outcome of our penetrating craniocerebral injury patients when compared to major US metropolitan series, current therapeutic strategies applied to this patient population in mid-Europe should be reconsidered. The results of our study justify an aggressive neurosurgical approach even in those patients that are thought to have a deleterious prognosis. Predictive variables identified in this study and a novel CT-grading algorithm may help in decision making.