RESUMO
RESUMEN Las heridas craneocerebrales penetrantes más frecuentes son las provocadas por armas de fuego; las restantes resultan de rara frecuencia. Se presentó un caso que recibió agresión craneoencefálica por arpón, de forma accidental, fuera del agua. Se describieron los detalles del suceso, los exámenes complementarios, la conducta adoptada, el manejo neuroquirúrgico, y la sorprendente evolución postoperatoria del paciente (AU).
ABSTRACT The most frequent penetrating craniocerebral wounds are those caused by firearms; the remaining ones are rare. We presented a case that received accidental cranioencephalic aggression by harpoon, an event that occurred out of the water. Details of the event, complementary examinations, adopted behavior and neurosurgical management that were decided, as well as the surprising post-operative evolution of the patient were described (AU).
Assuntos
Humanos , Masculino , Feminino , Adolescente , Ferimentos Penetrantes/cirurgia , Traumatismos Cranianos Penetrantes/diagnóstico , Ferimentos Penetrantes/diagnóstico por imagem , Radiografia/métodos , Evolução Clínica/métodos , Traumatismos Cranianos Penetrantes/cirurgia , Traumatismos Cranianos Penetrantes/diagnóstico por imagemRESUMO
RATIONALE: Penetrating brain injury caused by a welding electrode is a rare occurrence. This type of injury requires careful preoperative assessment and timely treatment measures to avoid secondary damage. PATIENT CONCERNS: A 55-year-old male patient fell from a height of approximately 5 m during when a welding electrode in his left hand was inadvertently inserted into his brain. The patient had a GCS score of 15 and complaints of dizziness and headache. CT showed an object of metallic density penetrating the skull and entering the brain parenchyma in the frontotemporal region. DIAGNOSIS: According to the clinical findings and preoperative imaging examination, the diagnosis was open craniocerebral injury with intracranial foreign body and left orbital wall fracture. INTERVENTION: After definite diagnosis and sufficient preoperative preparation, active surgical treatment was carried out to remove intracranial foreign body. Anti-infection and other symptomatic treatment were given after operation. The signs of infection and changes of vital signs were closely observed. OUTCOMES: After treatment, no obvious adverse reactions were found and the patient was discharged. No complications such as infection occurred during the follow-up period of 6 months. LESSONS: In treating patient with a welding electrode penetrating the brain, assessments need to be made preoperatively, the welding electrode needs to be removed in a timely manner, complete hemostasis needs to be achieved during surgery with total repair of the damaged area, and anti-inflammatory treatment needs to be administered postoperatively to achieve good results.
Assuntos
Acidentes por Quedas , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/terapia , Soldagem , Lesões Encefálicas Traumáticas/etiologia , Corpos Estranhos , Traumatismos Cranianos Penetrantes/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 25-year-old man presented to the trauma department following a penetrating stab wound to his left infraorbital margin with retained knife blade causing superoposterior displacement of the globe. Plain skull X-ray revealed an extensive retained blade with subsequent CT imaging revealing the tip of the blade had reached the right styloid process with no neurovascular compromise. Initial concern was primarily for the left eye leading to ophthalmology being the first specialty requested to review the patient. However, once the extent of the injury was established, ophthalmology requested further review from maxillofacial, ENT and neurosurgery. This resulted in an 84 hours wait between the initial injury and the removal of the knife blade. Incredibly, the patient had no initial sequelae from such an extensive injury and had an unremarkable recovery with no further complications aside from a laceration to the left inferior rectus muscle that was conservatively managed.
Assuntos
Corpos Estranhos/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Ferimentos Perfurantes/diagnóstico , Adulto , Corpos Estranhos/terapia , Traumatismos Cranianos Penetrantes/terapia , Humanos , Masculino , Incerteza , Ferimentos Perfurantes/terapiaRESUMO
BACKGROUND: Intracranial nail gun injury is a rare traumatic event and can result from a suicide attempt. Cerebral angiography is essential in the evaluation of damage to the intracranial vessels, and surgical removal of nails is generally the optimal treatment. Intraventricular hemorrhage can happen after removal of intracranial nails. Endovascular surgery or intraoperative computed tomography has been reported to be useful for detection and treatment of intraventricular hemorrhage. After the surgical removal of nails, attention should be paid for complications such as pseudoaneurysm and infection. CASE DESCRIPTION: A 63-year-old man with a history of depression was transferred to our hospital in an unconscious state. Physical examination showed 2 nails puncturing his left thorax, and computed tomography revealed a nail puncturing the intracranial space. No damage to these intracranial vessels was observed on computed tomography angiography and venography. After drainage for potential intraventricular hemorrhage, the nails were removed. Postoperatively, prophylactic antibiotic therapy was administrated for secondary infection. Computed tomography angiography did not detect any postoperative pseudoaneurysms. The patient also underwent therapy from a psychiatrist and was transferred to another hospital. CONCLUSIONS: As for treatment of a case of intracranial nail gun injury, our case shows that preoperative cerebral angiography is not always needed in intracranial nail gun injury when there is no apparent damage to the intracranial vessels and emergent removal of nails is required. External ventricular drainage preceding the removal of a puncture object can be an effective management strategy for secondary intraventricular hemorrhage.
Assuntos
Hemorragia Cerebral/cirurgia , Drenagem , Traumatismos Cranianos Penetrantes/cirurgia , Unhas/lesões , Angiografia Cerebral/métodos , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Traumatismos Craniocerebrais/cirurgia , Drenagem/efeitos adversos , Traumatismos Cranianos Penetrantes/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodosRESUMO
Penetrating traumatic brain injury (PTBI) is one of the major cause of death and disability worldwide. Previous studies with penetrating ballistic-like brain injury (PBBI), a PTBI rat model revealed widespread perilesional neurodegeneration, similar to that seen in humans following gunshot wound to the head, which is unmitigated by any available therapies to date. Therefore, we evaluated human neural stem cell (hNSC) engraftment to putatively exploit the potential of cell therapy that has been seen in other central nervous system injury models. Toward this objective, green fluorescent protein (GFP) labeled hNSC (400,000 per animal) were transplanted in immunosuppressed Sprague-Dawley (SD), Fisher, and athymic (ATN) PBBI rats 1 week after injury. Tacrolimus (3 mg/kg 2 days prior to transplantation, then 1 mg/kg/day), methylprednisolone (10 mg/kg on the day of transplant, 1 mg/kg/week thereafter), and mycophenolate mofetil (30 mg/kg/day) for 7 days following transplantation were used to confer immunosuppression. Engraftment in SD and ATN was comparable at 8 weeks post-transplantation. Evaluation of hNSC differentiation and distribution revealed increased neuronal differentiation of transplanted cells with time. At 16 weeks post-transplantation, neither cell proliferation nor glial lineage markers were detected. Transplanted cell morphology was similar to that of neighboring host neurons, and there was relatively little migration of cells from the peritransplant site. By 16 weeks, GFP-positive processes extended both rostrocaudally and bilaterally into parenchyma, spreading along host white matter tracts, traversing the internal capsule, and extending â¼13 mm caudally from transplantation site reaching into the brainstem. In a Morris water maze test at 8 weeks post-transplantation, animals with transplants had shorter latency to platform than vehicle-treated animals. However, weak injury-induced cognitive deficits in the control group at the delayed time point confounded benefits of durable engraftment and neuronal differentiation. Therefore, these results justify further studies to progress towards clinical translation of hNSC therapy for PTBI.
Assuntos
Diferenciação Celular/fisiologia , Transtornos Cognitivos/terapia , Traumatismos Cranianos Penetrantes/terapia , Células-Tronco Neurais/transplante , Neurônios/fisiologia , Transplante de Células-Tronco/métodos , Animais , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Transtornos Cognitivos/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Humanos , Distribuição Aleatória , Ratos , Ratos Endogâmicos F344 , Ratos Nus , Ratos Sprague-DawleyRESUMO
A 58-year-old man presented to the neurosurgical emergencies for a transzygomatic transcranial stab wound with a retained broken knife. The patient was neurologically intact. After radiographic evaluation the knife was found to be penetrating the temporal lobe, neighboring the intracavernous portion of the carotid artery. The patient was successfully managed in a conservative way. No abnormalities were seen at 12 months of follow-up. Dealing with penetrating head injuries is a usual condition in neurosurgical practice. Some situations are though really challenging, especially when the offending object is still in place, with a close connection to vital structures. This clinical reports an unusual penetrating head injury, highlighting the importance of careful radiographic evaluation and trying to discuss clear management options.
Assuntos
Traumatismos Cranianos Penetrantes/terapia , Ferimentos Perfurantes/terapia , Zigoma/lesões , Traumatismos Cranianos Penetrantes/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ferimentos Perfurantes/diagnóstico , Zigoma/diagnóstico por imagemRESUMO
Las lesiones intracraneales penetrantes trans-orbitarias representan pocos casos de todos los Traumas Craneo-encefálicos, sin embargo, representan del 25 al 50 por ciento de todos los traumas penetrantes craneales. Este tipo de traumas trans-orbitarios se han reportado por diferentes tipos de objetos, incluyendo objetos de metal y de madera. Muchos de estos traumas intracraneales pueden pasar desapercibidos en casos donde el material que ingresa no queda expuesto posterior al trauma y cuando no se presenta lesión neurológica que requiera examinación exhaustiva adicional con neuro-imágenes.
Trans-orbital penetrating intracranial injuries represent few cases of all Traumatic Brain Injuries, although they represent between 25 to 50 percent of all penetrating brain injuries. Trans-orbital intracranial penetrating injuries have been reported caused by different types of objects, including metal and wooden objects. Many of these intracranial traumas can be dismissed, especially in those cases where the material is not exposed after the injury and there is no need of further examination with neuroimaging in absence of neurological deficit.
Assuntos
Humanos , Lesões Encefálicas Traumáticas , Lesões Encefálicas Traumáticas/fisiopatologia , Fraturas Orbitárias , Órbita/anatomia & histologia , Órbita/lesões , Traumatismos Cranianos Penetrantes/diagnóstico , Angiografia por Ressonância Magnética/métodos , Corpos Estranhos , Tomografia Computadorizada Espiral/métodosRESUMO
BACKGROUND: Penetrating nonmissile injuries to the head are far less common than missile penetrating injuries. Here we describe our experience in managing 17 cases of nonmissile injury to the head, likely the largest such series reported to date. We also highlight the surgical steps and techniques used to remove in situ objects (including weapons) in the penetrating wounds that have not been described previously. METHODS: We conducted a retrospective study of cases of nonmissile, low-velocity penetrating injuries of the head managed in our department. The recorded data of patients with penetrating head injuries were studied for the cause of the injury, type of object, type and extent of penetration, Glasgow Coma Scale score on admission, other clinical issues, evaluation and assessment, interval from penetration to operation, surgical steps and notes, difficulty during the operation, major and minor complications, follow-up, and ultimate outcome. RESULTS: Our 17 cases included 6 cases of accidental penetration and 11 cases of penetration as the result of violence. Weapons and other foreign objects causing injury included a teta (a pointed metal weapon with a wooden handle and a barb near the tip, used for hunting and fishing) in 4 cases, a dao (a sharp metal cutting instrument with a wooden handle used for cutting vegetables, fish, meat, bamboo, wood, etc.) in 3 cases, a bamboo stick in 3 cases, a metal rod in 2 cases, a knife in 2 cases, a sharp stone in 1 case, a metal steam chamber cover in 1 case, and a long peg in 1 case. GCS on admission was between 13 and 15 in 15 cases. Only 1 patient exhibited limb weakness. Four patients with an orbitocranial penetrating injury had 1-sided vision loss; 2 of these patients had orbital evisceration, and 1 of these patients died. In 14 patients, the foreign object was in situ at presentation and was removed surgically. Computed tomography scan and plain X-ray of the head were obtained in all patients. Postoperatively, 2 patients (11.7%) needed support in the intensive care unit but died early after surgery. One patient developed late osteomyelitis. The remaining patients were doing well at the most recent follow-up. CONCLUSIONS: The presenting picture of nonmissile penetrating injury to head may be daunting, but these cases can be managed with very good results with proper (clinical and radiologic) evaluation and simple neurosurgical techniques.
Assuntos
Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/cirurgia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Criança , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Traumatismos Cranianos Penetrantes/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Procedimentos Neurocirúrgicos/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
The results of examination and treatment of 36 injured persons with complicated penetrating thoracic woundings in tertiary centres were analyzed. Own experience of the pulmonary woundings surgical treatment, using application of videothoracoscopic and welding-coagulating equipment, was summarized.
Assuntos
Traumatismos Abdominais/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Hemotórax/cirurgia , Pneumotórax/cirurgia , Traumatismos Torácicos/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/patologia , Eletrocoagulação/instrumentação , Eletrocoagulação/métodos , Serviço Hospitalar de Emergência , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/patologia , Hemotórax/diagnóstico , Hemotórax/diagnóstico por imagem , Hemotórax/patologia , Hospitais , Humanos , Pneumotórax/diagnóstico , Pneumotórax/diagnóstico por imagem , Pneumotórax/patologia , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/patologia , Cirurgia Torácica Vídeoassistida/instrumentação , Cirurgia Torácica Vídeoassistida/métodos , Índices de Gravidade do Trauma , Ucrânia , Ultrassonografia , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/patologiaRESUMO
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus (CS), and can occur as a result of blunt and penetrating head injuries. While occurrence is rare, diagnosis can be made in the emergency department. Described in the present report is the case of a 26-year-old man who presented with complaints of pain, redness, blurred and loss of vision in the right eye, and swelling of the upper face due to a gunshot injury he had sustained 35 days prior.
Assuntos
Fístula Carótido-Cavernosa/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Ferimentos por Arma de Fogo , Adulto , Cegueira/etiologia , Fístula Carótido-Cavernosa/complicações , Fístula Carótido-Cavernosa/diagnóstico por imagem , Fístula Carótido-Cavernosa/cirurgia , Diagnóstico Diferencial , Procedimentos Endovasculares , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , MasculinoRESUMO
In the last few years, a growing number of cases have been reported in Germany in which vending machines have been blasted by criminals to get at the money. Thus, it was only a question of time for the first fatalities to occur as a consequence of such careless explosions. We report on the death of a 16-year-old boy who died after triggering an explosion by spraying a deodorant into the coin slot of a cigarette machine. Death was caused by severe craniocerebral trauma due to tertiary blast-related injuries when the front plate of the machine hit the victim's cerebral and facial skull.
Assuntos
Traumatismos por Explosões/diagnóstico , Explosões , Corpos Estranhos/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismo Múltiplo/diagnóstico , Roubo , Adolescente , Evolução Fatal , Distribuidores Automáticos de Alimentos , Humanos , Masculino , Produtos do TabacoRESUMO
A 26-year-old man was injured in a motor vehicle accident. He sustained a compound orbital fracture with brain contusion. The brain tissue protruded through the orbit. Computed tomography showed a long contusion with a moderate amount of hematoma in the right frontal lobe. No foreign body was observed in the cranium. On 3D CTA, the major cerebral vessels were found to be intact. An urgent surgery was first performed by neurosurgeons and subsequently by ophthalmologists. The periosteum was left on the skull. A frontal periosteal, a right temporal fascial, and a right temporal muscular flap were prepared. After debridement and irrigation, the dural tear was closed with the right periosteal and fascial flaps. Finally, the frontal fascia was used to cover the orbital defect. The patient's clinical course was favorable. The patient was able to walk when discharged 46 days after the surgery. A penetrating brain injury through the orbit is rare, and its treatment is not established. A key to successful management of this injury is immediate assessment. Foreign bodies in the cranium, especially metal, should be checked for immediately. The cerebral vessels should also be evaluated. Usually, a surgical intervention is necessary. Since bone reconstruction can be associated with a risk of infection, a multi-layered closure, as described in this report, could prevent leakage of cerebrospinal fluid and subsequent meningitis.
Assuntos
Lesões Encefálicas/cirurgia , Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Órbita/cirurgia , Procedimentos de Cirurgia Plástica , Crânio/cirurgia , Adulto , Corpos Estranhos/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Humanos , Masculino , Resultado do TratamentoRESUMO
INTRODUCTION: In many parts of the world, access to a CT scanner remains almost non-existent, and patients with a head injury are managed expectantly, often with poor results. Recent military medical experience in southern Afghanistan using a well-equipped surgical facility with a CT scanner has provided new insights into safe surgical practice in resource-poor environments. METHODS: All cases of children aged under 16 years with penetrating head injury who were treated in a trauma unit in southern Afghanistan by a single neurosurgeon between 2008 and 2010 were reviewed. Based on a previously published retrospective review, a clinical strategy aimed specifically at generalist surgeons is proposed for selecting children who can benefit from surgical intervention in environments with no access to CT scanners. RESULTS: Fourteen patients were reviewed, of whom three had a tangential wound, 10 had a penetrating wound with retained fragments and one had a perforating injury. Two operations for generalist surgeons are described in detail: limited wound excision; and simple decompression of the intra-cranial compartment without brain resection or dural repair. CONCLUSIONS: In resource-poor environments, clinically-based criteria may be used as a safe and appropriate strategy for selecting children who may benefit from relatively straightforward surgery after penetrating brain injury.
Assuntos
Serviços Médicos de Emergência , Traumatismos Cranianos Penetrantes , Adolescente , Campanha Afegã de 2001- , Afeganistão , Altruísmo , Criança , Pré-Escolar , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/métodos , Feminino , Cabeça/patologia , Cabeça/cirurgia , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Penetrating brain injury(PBI)is very rare in Japan. Because there is a very wide variety of pathological condition of PBI, the guideline for the treatment of PBI has not been established yet. We report the unique case of PBI caused by a steel wire piece completely embedded in the brain parenchyma. A 75-year-old man was brought to the emergency department due to ocular injury caused by a steel wire piece. Neurological examination revealed only left visual disturbance. CT scan revealed a steel wire piece located intraparenchymally between the left frontal lobe and the ventricles, but digital subtraction angiography showed no significant vascular injury in the surrounding structures. We performed an open surgery and removed the steel wire piece. Because the steel wire piece was completely embedded in the brain, we used intraoperative X-ray fluoroscopy to choose a less invasive approach for the brain. The patient suffered no additional neurological deficit and no sign of cerebral infection or seizure after surgery. He was discharged after a 4-week administration of antibiotics. In most cases of PBI caused by low velocity injury, foreign bodies are not completely embedded in the brain except for remnants after surgical removal. This is the first report of low velocity PBI caused by a foreign body completely embedded in the brain.
Assuntos
Hemorragia Cerebral/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Aço , Ferimentos Penetrantes/cirurgia , Idoso , Angiografia Digital/métodos , Traumatismos Cranianos Penetrantes/diagnóstico , Humanos , Masculino , Resultado do Tratamento , Ferimentos Penetrantes/diagnósticoRESUMO
Acute penetrating injuries to the head and neck cause considerable anxiety for most clinicians owing to concern for airway control and neurologic injury and to limited clinician experience in most centres. This article discusses an organized approach to the evaluation and initial treatment of penetrating injuries to the head and neck based on regional anatomy and clinical examination. The approach is particularly helpful in the context of ongoing hemorrhage and/or airway compromise.
Assuntos
Traumatismos Craniocerebrais , Lesões do Pescoço , Ferimentos Penetrantes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/terapia , Traumatismos Faciais/diagnóstico , Traumatismos Faciais/terapia , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/terapia , Humanos , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/terapiaRESUMO
Penetrating brain injury (PBI) may be caused by low-velocity or high-velocity objects. Several objects are known to cause such injury ranging from knives to rooster pecks. However, an assault with the key of a bike causing PBI has not been reported in the literature. The objective of this study was to report the case of a 21-year-old male patient, who presented after an assault with a bike key. The key was impacted in the left parietal region. Left parietal craniotomy was done and the key was removed. There was an underlying parenchymal contusion, which was excised. On post-operative day two, the patient developed motor aphasia, which subsided in subsequent days with antiedema measures. At the first month follow-up, the patient was having normal speech and consciousness. Prompt treatment of penetrating brain injury is important and angiography is not always necessary for PBI.
Assuntos
Traumatismos Cranianos Penetrantes/diagnóstico , Osso Parietal/lesões , Ciclismo , Craniotomia , Crime , Diagnóstico Diferencial , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Humanos , Masculino , Adulto JovemRESUMO
Owing to the diversity in cause and damage, there is no standard surgical treatment method for a complicated penetrating craniofacial injury. The treatment of a complicated penetrating head injury caused by a steel bar is presented here. A 66-year-old woman fell onto a steel bar at a construction site and it penetrated the mandible, entered the sinus and orbital cavities, and reached the base of the frontal bone. A multi-disciplinary team including a neurosurgeon, otolaryngologist, and plastic surgeon was involved in removing the steel bar. The patient survived without sequelae except for blindness in the right eye. Despite the lack of standardized surgical treatment for a complicated penetrating craniofacial injury, aggressive treatment by a multidisciplinary team can result in good outcomes.
Assuntos
Corpos Estranhos no Olho/diagnóstico , Traumatismos Cranianos Penetrantes/diagnóstico , Acidentes por Quedas , Idoso , Diagnóstico Diferencial , Corpos Estranhos no Olho/diagnóstico por imagem , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Ferimentos Oculares Penetrantes/cirurgia , Feminino , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Aço , Tomografia Computadorizada por Raios XRESUMO
It is important to improve the medical care system and treatment of victims, introduce new methods of treatment and attract the multidisciplinary specialists in the cases of multitrauma. An integrated approach is required for the identification of different character and severity of multiple craniofacial injuries and the development of rational surgical strategy on this base. Different scales such as AIS, CRIS, ISS, PTS, TRISS, TRISSCAN, CRAMS et.al, were created abroad. Another approach to medical strategy was developed in the department of military surgery of Kirov Military Academy in the late nineties. It was based on investigating of possibilities of surgical strategy optimization by application of objective evaluation of the severity of injuries (military surgery--SP, SG, SS). Given treatment strategy of victims with multiple craniofacial trauma resulted in double reduction of quantity of suppurative and septic complications (from 10.5% to 4.1%). It gave the possibility to reduce the lethality from 6.4% to 4.0%. At the same time a hospital stay was shortened and the strategy allowed obtaining satisfactory functional results of treatment and avoiding reinterventions for removal of posttraumatic facial deformations.
Assuntos
Traumatismos Faciais , Traumatismos Cranianos Penetrantes , Osteomielite/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Fraturas Cranianas , Cirurgia Vídeoassistida , Adulto , Endoscopia/efeitos adversos , Endoscopia/métodos , Traumatismos Faciais/diagnóstico , Traumatismos Faciais/mortalidade , Traumatismos Faciais/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/mortalidade , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Masculino , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/mortalidade , Traumatismo Múltiplo/cirurgia , Osteomielite/etiologia , Federação Russa , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/mortalidade , Fraturas Cranianas/cirurgia , Índices de Gravidade do Trauma , Resultado do Tratamento , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/métodosRESUMO
OBJECTIVE: Toward the end of 2010, the Arab spring, the waves of revolutionary demonstrations and protests influenced also Syria, where violent clashes turned into a civil war. Hundreds of thousands of people became refugees. The use of excessive force unfortunately culminated in numerous deaths and injuries in many cities. Being the closest city to Aleppo, Damascus and Homs, the biggest cities of Syria, Antioch/Hatay has been the city where initial emergency treatments were performed. For this reason, we examined and retrospectively analyzed the medical records of the patients treated in the clinics of our hospital due to cranial gunshot wounds during the war. MATERIAL AND METHODS: The medical records of 186 patients who were injured in the Syrian War and brought to, followed up and treated in the Neurosurgery Clinic of Mustafa Kemal University, Faculty of Medicine in Hatay, a Turkish city on the Syrian border, between April 2011 and June 2013. RESULTS: A total of 186 patients were evaluated in a period of more than 2 years. Of all 91.4% of the patients were adults (male/female: 152/18) and 8.6% of them were pediatric patients (male/female: 14/2). The average age of the patients was 31 years, with an age range of between 2 months and 67 years. According to Glasgow coma score (GCS) of the patients at the time of admission, GCS was 3 in 32 patients (17.2%), between 4 and 7 in 70 patients (37.6%), and between 8 and 15 in 84 patients (45.1%). We observed that the patients with GCS of 4-7 had a significantly lower mortality among the 56 patients treated surgically compared with the 14 patients treated medically. DISCUSSION: Cranial gunshot wounds are responsible for high mortality and morbidity. A multiplicity of factors plays a role on morbidity and mortality. These are the duration of transport, the injury pattern, the velocities of the weapons used, and the Glasgow Coma Scales of the patients at the time of admission. CONCLUSION: The authors recommend that the patients with cranial gunshot wounds who has GCS of 4-7 should be aggressively treated including surgery as well. We do not recommend surgical treatment for patients with GCS of 3. All our experiences show that treatment of gunshot wounds will continue to be a matter of debate, about which there is more to learn. The data presented in this study will once again demonstrate the seriousness of the event, and will, perhaps, contribute to the peace negotiations to end the war.
Assuntos
Traumatismos Cranianos Penetrantes/cirurgia , Crânio/patologia , Ferimentos por Arma de Fogo/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síria , Guerra , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/patologia , Adulto JovemRESUMO
Meningiomas are common and mostly benign intracranial tumors, which originate from arachnoid cells of the meninges, and account for approximately 25% of all primary intracranial tumors. Many external etiological factors have been described as etiology of meningioma in the literature, one of which is head trauma. However, trauma as a cause of meningioma remains a controversial subject. Here, a case of a patient with posttraumatic meningioma, who was wounded 25 years before, is presented. The assessment of the clinical characteristics of the patient and those reported in the literature seem to confirm that, in some cases, head trauma may be a factor contributing to the development of meningioma.