Novedosa técnica para retiro de proyectil de exobase de cráneo guiada por endoscopia a través de sistema de dilatadores tubulares utilizados para cirugía mínimamente invasiva de columna. A propósito de un caso / A novel technique for removal of skull exobase projectile guided by endoscopy through a system of tubular dilators used for minimally invasive spine surgery. About a case

Las heridas de arma de fuego en la región craneofacial representan una actividad con frecuencia en aumento en la actividad médica, y su gravedad depende del tipo de arma utilizada y la distancia del impacto. Entre ellas, las producidas por proyectiles de baja energía producen heridas con un perfil característico, que son una pequeña puerta de entrada con destrucción mínima de tejido inicial, generalmente sin orificio de salida por perder velocidad al contactar con estructuras óseas. El resultado de esto es que el proyectil se aloja en la profundidad del complejo craneofacial, lo cual demanda al cirujano un amplio conocimiento y manejo anatómico para su abordaje. En el presente artículo se describe una novedosa técnica para retiro de proyectil de la fosa pterigomaxilar, guiada por endoscopia a través de un sistema de dilatadores tubulares utilizados para cirugía mínimamente invasiva de columna, en un paciente masculino de 14 años. Luego del retiro del mismo, se continúa con los controles posoperatorios alejados, sin intercurrencias, asintomático e inserto en sus actividades diarias, con una cicatriz mínima, y sin atrofia de la región temporal. Los estudios por imágenes de control visualizan el correcto retiro del cuerpo extraño, con estructuras adyacentes sin lesiones a considerar

Gunshot wounds in the craniofacial region represent an increasingly frequent activity in medical activity, and its severity depends on the type of weapon used and the distance of the impact. Among them, those produced by low-energy projectiles produce wounds with a characteristic profile, which are a small entrance door with minimal initial tissue destruction, generally without an exit hole due to losing speed when contacting bone structures. The result of this is that the projectile lodges deep in the craniofacial complex, which requires the surgeon to have extensive knowledge and anatomical management for its approach. This article describes a novel technique for projectile removal from the pterygomaxillary fossa, guided by endoscopy through a system of tubular dilators used for minimally invasive spine surgery, in a 14-year-old male patient. After its removal, he continued with remote postoperative controls, without complications, asymptomatic and active in his daily activities, with a minimal scar, and without atrophy of the temporal region. Control imaging studies visualize the correct removal of the foreign body, with adjacent structures without injuries to consider.

Suicidio mediante el uso de un arma de fuego, con presencia de doble Signo de Hoffmann: reporte de un caso / Firearm suicide with the presence of a double Hoffmann sign: case report

Resumen El presente artículo expone el caso de un suicidio de un masculino, el cual presentó dos orificios de entrada en la cabeza con características propias de un orificio de contacto, específicamente dos signos de boca de mina, también conocido como signo de Hoffmann.

Abstract This article presents the case of a suicide of a male, which presented two entry holes with characteristics of a contact hole in his head, two mine mouth signs, also known as Hoffman´s sign.

Trauma craneoencefálico penetrante por una herida de arpón. Presentación de un caso / Penetrating cranioencephalic trauma due to harpoon wound. Presentation of a case

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).

Prise en charge des plaies pénétrantes de l'abdomen de l'enfant au Centre hospitalier de Treichville / Management Of Penetrating Abdominal Wounds In Children At Treichville Teaching Hospital

Contexte. La prise en charge des plaies pénétrantes de l'abdomen chez l'enfant ne fait pas l'objet de consensus. Le dogme de laparotomie d'emblée est remis en cause au profi t d'un traitement conservateur à appliquer selon des critères précis. Notre objectif était de caractériser les aspects épidémiologiques, cliniques et thérapeutiques des plaies pénétrantes de l'abdomen afi n de proposer un algorithme de prise en charge. Méthodes. Etude rétrospective de Janvier 2009 à décembre 2019, au service de chirurgie pédiatrique du CHU de Treichville.Huit cas ont été colligés dans les dossiers de patients retrouvés et complets. L'analyse statistique a été faite par le test de Fisher. Résultats. L'âge médian était de 9 avec des extrêmes de 2 et 15 ans. Tous les patients étaient de sexe masculin. Quatre patients présentaient un tableau de péritonite.Tous nos patients étaient hémodynamiquement stables.La radiographie de l'abdomen sans préparation (ASP) a été faite chez 5 patients (62,5 %) avec un pneumopéritoine chez 3 patients.Il a été réalisé4 (50%) laparotomies d'emblée et 4 traitements conservateurs.Le test exact de Fisher était statistiquement signifi catif pour p<0,05. Aucune laparotomie secondaire n'a été réalisée après le traitement conservateur. La mortalité a été nulle Conclusion. Les critères de réalisation du traitement conservateur reposent sur la clinique et un plateau technique disponible.

Background: The management of penetrating wounds of the abdomen in children is not the subject of consensus. The dogma of surgical exploration from the outset is called into question in favor of a conservative treatment. This treatment, however, must be applied according to precise criteria. The aim of this study was to characterize the epidemiological, clinical and therapeutic aspects of penetrating abdominal wounds in order to propose an accurate management algorithm.Methods. We performed a retrospective study from January 2009 to December 2019, in the pediatric surgery department of the Teaching Hospital of Treichville. Eightcases were collected.The statistical analysis was done using Fisher's test.Results. The median age was 9 with extremes of 2 years and 15 years. All patients were male. All our patients were hemodynamically stable. Four presented a peritonitis.Abdomen X-ray (ASP) was performed in 5 patients (62.5%) with pneumoperitoneum in 3 patients (37.5%). Four laparotomies (50%) were performed immediately and 4 conservative treatments.Fisher's exact test was statistically signifi cant for p<0.05. No secondary laparotomy was performed after conservative treatment. Mortality was zero. Conclusion. The criteria for performing conservative treatment are based on clinical elements and a technical platform available.

Craniectomía descompresiva, una alternativa de tratamiento. Caso clínico / Decompressive craniectomy, an alternative treatment. Clinical case

Introducción: El Trauma Cráneo Encefálico Grave (TCE), continúa siendo un problema de preocupación para las autoridades sanitarias a nivel mundial. A pesar de las diferentes publicaciones existen divergencias en la toma de desición en aplicar la Craniectomía descompresiva (Cd). En el presente trabajo se describe caso clínico portador de Hematoma Epidural (HE), Hipertensión Endocraneana (HE), intervenido quirúrgicamente donde la información fue tomada de la historia clínica realizada en la Unidad de Cuidados Intensivos del Hospital Andino del Chimborazo, Riobamba, Ecuador, previa obtención del consentimiento informado. Presentación del caso: Paciente femenina de 18 años de edad que sufre Trauma craneoencefálico grave, hematoma epidural con efecto de masa y edema cerebral. Sometida a craniectomía descompresiva y tratamiento neurointensivo. Estadía en Unidad de Cuidados Intensivos de seis días, evolución favorable, ausencia de secuelas neurológicas. Conclusiones: La Craniectomía descompresiva mejora la Hipertensión endocraneana, disminuye la estadía UCI, y los días de ventilación mecánica, sin embargo los estudios actuales demuestran que esta intervención no mejora resultados finales. La Craniectomía Descompresiva primaria, en centros de escasos recursos de neuromonitoreo, puede constituir un proceder salvador. La craniectomía descompresiva está indicada en la segunda línea de tratamiento según la American Association of Neurological Surgeons.

Introduction: Serious Skull Trauma (SST), continues to be a problem of concern for health authorities worldwide. Despite the different publications there are divergences in the decision making in applying decompressive craniectomy (dc). In the present work, a clinical case of Epidural Hematoma (EH), Endocranial Hypertension (EH), surgically intervened was described, where the information was taken from the clinical history carried out in the Intensive Care Unit of the Andino del Chimborazo Hospital, Riobamba, Ecuador, after obtaining the informed consent. Presentation of the case: An 18-year-old female patient suffering from severe head trauma, epidural hematoma with mass effect and cerebral edema. Subjected to decompressive craniectomy and neurointensive treatment. Stay in the Intensive Care Unit for six days, favorable evolution, absence of neurological sequelae. Conclusions: Decompressive craniectomy improves intracranial hypertension, decreases ICU stay, and days of mechanical ventilation, however current studies show that this intervention does not improve final results. Primary Decompressive Craniectomy, in centers with scarce resources of neuromonitoring, can be a saving procedure. Decompressive craniectomy is indicated in the second line of treatment according to the American Association of Neurological Surgeons.

Does Nationality Matter for the Gunshot Brain Injury? Ten-Year Retrospective Observational Cadaveric Comparative Study for Gunshot TBI between Greece and Bulgaria / 대한신경손상학회지

OBJECTIVE: Penetrating brain trauma (PBT) caused by gunshot is one of the most lethal traumatic brain injuries (TBIs) and its management and confrontation is of great importance. METHODS: The authors searched retrospectively the archives from 2 similar autonomous laboratories of forensic science and toxicology in the Balkan peninsula for a 10-year period of time and included only fatal penetrating brain injuries. RESULTS: The study is conducted in 61 cadavers with gunshot PBT. All of the cadavers were victims of suicide attempt. The most common anatomical localization on the skull were the facial bones, followed by skull base, temporal and parietal bone, conducting a trajectory of the gunshot. Additional findings were atherosclerosis of the blood vessels and chronic diseases such as chronic obstructive pulmonary disease, cancer and fatty liver. CONCLUSION: PBI has a high mortality rate. There are factors and findings from the collected data differing between the 2 aforementioned nations. Either way, better preventative measures, gun control and healthcare system are highly necessary.

An overview of penetrating traumatic brain injuries at a major civilian trauma centre in South Africa

Background: This study reviews our experience with penetrating Traumatic Brain Injury (TBI) in order to define and describe the injury pattern and the outcome. A secondary aim of this study was to review the use of the Motor Score (M Score) and the Simplified Motor Score(SMS) to assess and triage patients with penetrating TBI. Methods: All patients with a TBI secondary to a penetrating mechanism were identified from the Hybrid Electronic Medical Registry at Pietermaritzburg Metropolitan Trauma Service (PMTS) from January 2012 to December 2014. Standard demographic data, need for neuro-surgical intervention, location of external wounds, CT findings and mortality where analysed. The Glasgow Coma Scale (GCS) M score and SMS score were specifically evaluated to determine the relationship between the individual motor component and patient outcome. Results: Over the two-year period January 2012­December 2014, a total of 384 patients were admitted following a penetrating TBI. There were 350 males and 34 females and of this total 7 (1.82%) died. The mechanism of injury was axe (30), bottle (34), gunshot wound (GSW)(22) and stab wound (298). The average age for axe injuries was 27 and bottle injuries was 30. The average age for firearms and knives was 29 and 30 respectively. Surgery was not required for 76.67% of patients. The need for surgery varied according to mechanism of injury. Axe injuries were treated non-operatively in 47.83%, bottle injuries in 87.50%, firearms 70% and knife injuries were treated non-operatively in 86.84% of cases.The overall survival rate for a penetrating head injury in this population is 98.16%. There were a total of 368 patients with a motor score of 6 of which one died. The survival rate was 99.7% and the mortality rate 0.3%. There were only 6 patients with a motor score of 5 and only 2 with a motor score of 4. The survival rate for both these groups was 100%. There was a total of 6 patients with a motor score of 1. There was a 100% mortality rate is this group. Conclusion: Penetrating TBI has a good prognosis. The vast majority of cases do not require neuro-surgical intervention. Poor motor score is associated with a poor outcome

Head injury burden in a major referral hospital emergency centre in Botswana

Introduction:This study describes the demographics, aetiology, emergency centre diagnosis and severity indicators of patients with head injuries presenting to the largest referral hospital emergency centre in Botswana.Methods:Cross-sectional retrospective data was collected from July 2015 to September 2015 for all emergency centre head injury presentations at Princess Marina Hospital. Information was extracted from emergency centre records regarding patient demographics, mechanism of injury, clinical observations, diagnosis, and treatment.Results:Three-hundred and sixty head injury patients presented to the emergency centre in the three months, averaging four per day. 80% were less than 40 years of age and males accounted for 69% of all presentations. 58% of injuries were listed as being accidental, 39% recorded from assaults and 38% from road traffic accidents. The most common emergency centre clinical diagnosis was concussion and the most common radiological diagnosis skull fracture. The median Glasgow Coma Scale was 15 with a range from 3 to 15; and, among patients for whom Revised Trauma Score could be calculated, 79% scored the lowest probability of death in the Revised Trauma Score.Discussion:Head injury disproportionately overburdened males in this study, and head injury aetiology and demographic picture was similar to regional data. Severity scoring using the Glasgow Coma Scale was only available among 66% of patients and Revised Trauma Score calculable in half of presentations. Only 55% of head injury patients were discharged from the emergency centre, despite the preponderance of low severity scores. Head CTs appear to have been over-utilised and implementation of a Traumatic Head CT guideline for our setting is proposed. This study improves understanding of the burden of head injury in Botswana and advocates for national referral guidelines for patients with head injury in Botswana

Repercusión social en la persona con traumatismo craneoencefálico / Social repercussion in the person with traumatic brain injury

Resumen

Introducción: el enfoque social de una lesión cerebral por traumatismo craneoencefálico, de primera instancia, tiene que ver con la adquisición de una discapacidad que tendrá un impacto importante sobre la función social de quién lo padece.

Desarrollo: incluye los aspectos de percepción y manejo del trauma craneoencefálico, el cual se manifiesta por deterioro físico o funcional con daño neuropsicológico, la presencia de lesiones primarias y lesiones secundarias denominadas insultos extra neurológicos interfieren en la atención, la memoria, las funciones frontales, la emoción y la conducta. La valoración neuropsicológica posterior al traumatismo craneoencefálico se enfoca al deterioro intelectual, la movilidad voluntaria y el nivel de conciencia.

Conclusiones: el entorno social de las personas con traumatismo craneoencefálico, de acuerdo con la magnitud de la lesión, pueden presentar reacciones antisociales, por lo tanto la intervención de un profesional neuroeducador es la mejor alternativa para mejorar las respuestas conductuales, cognitivas y de aprendizaje.

Abstract

Introduction: The social approach to a brain injury due to traumatic brain injury, first instance has to do with the acquisition of a disability, which will have a significant impact on the social function of who has it.

Development: Includes aspects of perception and management of cranioencephalic trauma, which is manifested by physical or functional impairment with neuropsychological damage, presence of primary lesions and secondary lesions called extra neurological insults interfere with attention, memory, frontal functions, emotion and behavior. The neuropsychological assessment after traumatic brain injury focuses on intellectual deterioration, voluntary mobility and level of consciousnes.

Conclusions: The social environment of people with traumatic brain injury, according to the magnitude of the injury, may present antisocial reactions; therefore the intervention of a neuroeducator is the best alternative to improve the behavioral, cognitive and learning responses.

Civilian penetrating gunshot injury to the neurocranium in Enugu

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004­2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Conclusions: Admitting GCS and bullet trajectory were predictive of outcome

Trauma intracraneal penetrante trans-orbitario: anatomía relevante, las dinámicas del trauma y los puntos clavepara el tratamiento / Trans-orbital intracranial penetrating trauma: relevant anatomy, trauma dynamics and treatment key points

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.

Traumatismo Cráneo Encefálico penetrante no asociado a proyectil. Presentación de un caso / Non-bullet related penetrating head trauma: case presentation

Introducción: Los traumatismos craneoencefálicos penetrantes son cada vez más frecuentes en la sociedad actual, por lo que el neurocirujano debe estar preparado para atenderlas, siguiendo las guías y recomendaciones para su manejo. Caso: Paciente masculino joven, quien recibió puñalada en el rostro, llegó a la sala de emergencia desorientado y hemiparético. Se comprobó la presencia de arma blanca intracraneal y luego de los exámenes de imagen se procedió en sala de operaciones a retirar el arma retenida, luego de hemostasia y cierre de fístula. Luego de la intervención quirúrgica, fue atendido en la Unidad de Cuidados Intensivos. El control tomográfico posoperatorio no evidenció sangrado. Hubo reversióncompleta de la hemiparesia, sin signos de fistula ni infección. El paciente tuvo una buena evolución hasta su egreso, 12 días más tarde. Discusión: Las imágenes tomográficas y de angiotomografía son de gran ayuda para el neurocirujano, quien precisa de esa información para prevenir potenciales complicaciones intraoperatorias y secuelas neurológicas en el tratamiento quirúrgico de pacientes que han sufrido un trauma craneoencefálico penetrante.

Introduction: Penetrating head injuries are becoming more and more frequent in nowadays socity, therefore, the neurosurgeon should be prepared to deal with. We must stick at rigid surgical protocols. Case: A young male patient stabbed on his face was admitted in the emergency unit of our hospital. He was disoriented and hemiparetic with a knife inside the skull shown by image examns. Patient was sent to the operating room where the neurosurgeon proceeded to remove the knife, under controlled conditions and hemostasis. A brain fistula was closed and the patient was sent to the Intensive Care Unit in the postoperative period. Tomographic control showed no bleeding. Eventually, he was discharged in good condition after 12 days with complete reversal of hemiparesis, without infection or fistula. Discusion: Tomographic imaging and angiography are useful tools for the neurosurgeon, who needs key information to prevent surgical complications and neurologic sequelae when dealing with patients who suffered penetrating head trauma.

Heridas por proyectil de arma de fuego en cráneo: revisión de la literatura / Firearm projectile wounds on skull: literature review

El trauma craneoencefálico es una de las principales causas de muerte en el mundo, y gran parte de estos se asocian a heridas por arma de fuego en cráneo. Conocer el manejo, las características y fisiopatología de la lesión nos permitirá saber abordar estos casos cuando se presenten a los diferentes centros asistenciales, al tiempo que nos permitirá tener en cuenta las posibles complicaciones, para evitar su aparición y así buscar mejorar la morbilidad por esta causa. Siempre acompañado de un manejo integral que permita abarcar todas las dimensiones afectadas.

Traumatic brain injury is a of the leading causes of death in the world, and many of these are associated with gunshot wounds in the skull. To know management the characteristics and pathophysiology of the lesion will tell as deal with these cases when presented to medical centers, while enabling us to take into account of possible complications, to prevent its occurrence and so try to improve morbidity from this cause. Always accompanied by an integrated management that can encompass all affected dimensions.

Lesiones penetrantes en el cerebro por cuerpos extraños intracraneales. Presentación de tres casos / Penetrating injuries in the brain by intracranial foreign bodies. Presentation of three cases

Fundamento: Las lesiones penetrantes cerebrales causadas por objetos extraños, incluidos proyectiles son comúnmente vistas en situaciones de guerra. Las lesiones no causadas por proyectiles son raras en la práctica neuroquirúrgica en la vida civil en tiempo de paz. Objetivo: Ilustrar formas clínicas y la evaluación de lesiones penetrantes del cerebro no causadas por municiones de armas de fuego en tiempo de paz, a través de la presentación de tres casos. Presentación de casos: Presentamos tres pacientes con cuerpos extraños intracraneales, el primero que durante intento suicida se introdujo a través de agujero de trépano objeto metálico (alambre de cobre); el segundo caso, paciente que al sufrir trauma de cráneo se le realizó tomografía axial computarizada de cráneo y se detectó la presencia de hematoma subdural agudo y cuerpo extraño intracraneal (pedazo de alambre); el tercer caso se trata de recluso que durante una riña sufrió herida con penetración de un cuerpo extraño intracraneal (clavo). Conclusiones: La intervención quirúrgica de estos pacientes de manera urgente y su estado neurológico al entrar al quirófano repercutió de manera decisiva en su evolución.

Background: Penetrating brain injuries due to foreign objects including gunshot wounds are commonly seen in war times. Injuries not caused by gunshot are rare in neurosurgical practice in civil lifetime in peace times. Objective: To illustrate the clinical forms and the evaluation of penetrating brain injuries not caused by ammunitions of firearms in peacetime, through the presentation of three cases. Cases presentation: We report three patients with intracranial foreign bodies, the first during suicide attempt was introduced via burr hole metal object (copper wire); the second case, the patient suffered head injury and underwent computed tomography of the skull and the presence of acute subdural hematoma and intracranial foreign body (piece of wire) was detected; the third case involves prisoner who suffered injury during a fight with intracranial penetration of a foreign body (nail). Conclusions: Urgently surgical intervention in these patients and their neurological status entering the operating room impacted decisively in their evolution.

Suicide bomb attack causing penetrating craniocerebral injury / 中华创伤杂志(英文版)

Penetrating cerebral injuries caused by foreign bodies are rare in civilian neurosurgical trauma, although there are various reports of blast or gunshot injuries in warfare due to multiple foreign bodies like pellets and nails. In our case, a 30-year-old man presented to neurosurgery clinic with signs and symptoms of right-sided weakness after suicide bomb attack. The skull X-ray showed a single intracranial nail. Small craniotomy was done and the nail was removed with caution to avoid injury to surrounding normal brain tissue. At 6 months'follow-up his right-sided power improved to against gravity.

Urgent Intracranial Carotid Artery Decompression after Penetrating Head Injury

We describe a case of intracranial carotid artery occlusion due to penetrating craniofacial injury by high velocity foreign body that was relieved by decompressive surgery. A 46-year-old man presented with a penetrating wound to his face. A piece of an electric angular grinder disc became lodged in the anterior skull base. Computed tomography revealed that the disc had penetrated the unilateral paraclinoid and suprasellar areas without flow of the intracranial carotid artery on the lesion side. The cavernous sinus was also compromised. Removal of the anterior clinoid process reopened the carotid blood flow, and the injection of glue into the cavernous sinus restored complete hemostasis during extraction of the fragment from the face. Digital subtraction angiography revealed complete recanalization of the carotid artery without any evidence of dissection. Accurate diagnosis regarding the extent of the compromised structures and urgent decompressive surgery with adequate hemostasis minimized the severity of penetrating damage in our patient.

A rare case of penetrating cranial trauma by knife with direct lesion to the anterior cerebral artery

Las lesiones penetrantes en el cráneo por lo general se asocian con alta mortalidad. Ellos pueden ser el resultado de numerosos eventos, la mayoría de ellos están causados por un trauma de alta energía. La perforación de un cráneo por los objetos de baja energía cinética es inusual en la práctica neuroquirúrgica. Un alto porcentaje de los casos con lesiones penetrantes craneales se asocian con lesiones vasculares, lo que requiere el estudio de la vascularización intracraneal para una conducta médica adecuada. Presentamos un caso de una paciente de 32 años de edad que sufrió un trauma penetrante en el cráneo con un cuchillo a través de los huesos del cráneo, con lesión directa a la arteria cerebral anterior, e incluimos una breve revisión de la literatura sobre el tema.

The penetrating injuries of the skull are usually associated with high mortality. They may be the result of numerous events, the majority of them being caused by high energy trauma. Penetrating brain injury by objects of low kinetic energy is unusual in the neurosurgical practice. A high percentage of the cases with penetrating injuries is associated with cranial vascular lesions, requiring study of the intracranial vasculature for proper management. We report on a case of a 32-year-old patient who suffered a head-penetrating trauma by a knife through the bones of the skull, with direct injury to the anterior cerebral artery, including a brief review of the literature on the theme.