Rupture of the Superior Sagittal Sinus in Penetrating Head Injury—Management of a Rare Trauma Mechanism

Civilian penetrating head injury caused by foreign objects is rare in Germany (Europe), but can result in complex neurovascular damage. We report on a patient who in suicidal intent inflicted on himself a penetrating brain injury near the vertex with a captive bolt gun. A laceration at the junction of the middle to the posterior third of the superior sinus occurred by bolt and bone fragments leading to critical stenosis and subsequent thrombosis. Upon surgery, the proximal and distal sinus openings were completely thrombosed. The sinus laceration was closed by suture and the intraparenchymal bone fragments were retrieved. Postoperative angiography disclosed persistent occlusion of the superior sagittal sinus. The patient did not develop any symptoms due to venous congestion (edema, hemorrhage), suggesting sufficient collateral venous outflow. The patient completely recovered despite the complexity of the lesion.

Multiple Nail Gun Penetrating Head Injury: A Case Report

Intracranial nail gun injury is a rare subset of penetrating head injury. Here we report a case of intracranial nail gun injury in a Vietnamese patient who attempted suicide with no neurological deficit. Three nails were launched. Because the nail head acted as a brake, the launched nail could make a hole into the skull but could not entirely pass it. A rational management strategy should permit these patients to be discharged with no additional injury. Some medical and surgical management in penetrating head injury are discussed. The use of antibiotics and antiepileptic drugs and the retraction of the nail aided by the performance of a craniotomy surrounding the entry point are recommended.

Factors affecting the outcome in surgically treated civilian penetrating head injury: Case series

Penetrating brain injury (PBI) is any injury that causes penetration of the scalp, skull, meninges, and brain. It is a traumatic brain injury caused by either low-velocity sharp objects (e.g. a knife), high-velocity projectiles (shell fragment or bullets) or blast injury is the consequence of the detonation of complex explosives with or without PBI and closed head injury. To evaluate the factors (pre-operative and operative) that affect the surgical outcome of civilian PBI. This study was done from February 2017 to October 2018 prospectively & retrospectively. The study involved only the civilian patients that got a penetrating head injury and surgically treated in Neurosurgical Teaching Hospital/Baghdad/Iraq. The data include thirty-nine (39) operated patients with PBI. Data information includes the Glasgow Coma Scale (GCS), radiological investigations (computerized tomov graphy (CT-scan) and plain X-ray) the outcome determined by Glasgow Outcome Score (GOS). The patients were followed up during the time of hospitalization. The surgical outcome of the penetrating head injury in this study was assessed by GOS and was as follow, good recovery 10 patients (25.6%), moderately disabled 11 patients (28.2%), severely disabled 5 patients (12.8%), vegetative 6 patients (15.4%), Dead 7 patients (18.0%). Good outcome 21 patients 53.8% while poor outcome 18 patients 46.2%. GCS is significant factor (p-value = 0.002), time not affecting, CT-finding is significant factor (p-value = 0.000), blood pressure >= 90 mm Hg is a good predictor factor (p-value =0.001), speech difficulty is poor predictor factor (p-value = 0.004), outcome of inlet alone better than inlet and outlet. There are many factors affecting the surgical outcome in civilian penetrating head injury, and the significant factor is pre-operative GCS, CT-scan which is the best radiological investigation for pre-operative and post-operative assessment and show the details of the injury, blood pressure > = 90 mm Hg which is a good prognostic factor.

Pediatric gunshot penetrating head injury: a case report with 2-year follow-up

Gunshot is a rare subset of penetrating head injury, and generally the victim dies before arriving at the hospital. This paper reported a case of an intracranial gunshot injury in a 12 year-old boy that was shot by his friend, whose primary intention was to play around, using a revolver. A missile projectile penetrated from mid frontal and came out from right occipital. Vital signs were stable with GCS 8 from physical examination. A rational management strategy should permit a good outcome. The only complications that occured were hydrocephalus, yet it was managed by VP–shunt. Skull defect was closed using titanium mesh. A two-year follow-up showed a good result. The patient was able to do daily activity and back to school again.