Citation

Chowdhury FH, Haque MR, Hossain Z, Chowdhury NK, Alam SM, Sarker MH. World Neurosurg. 2016; 94: 529-543.

Affiliation

Department of Neurosurgery, Dhaka Medical College & Hospital, Dhaka, Bangladesh.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.wneu.2016.06.062

PMID

27350299

Abstract

OBJECT: Penetrating non-missile injury to head is far less common in comparison to missile penetrating injury. Here we describe our experiences of management of 17 cases of non-missile injury to head, which is probably the largest series in the literature. We also highlight on simple surgical steps and techniques of removal of in situ objects (weapon) in the penetrating wound that were not previously described.

METHOD: We retrogradely studied the non-missile, low velocity penetrating injury of head cases that were admitted and managed in our department. The recorded data of the patients with penetrating head injuries were carefully studied for cause of violence, type of weapon, type of penetration, GCS on admission, other clinical pictures, investigation, time interval from penetration to operation, surgical steps and notes, difficulties at operation, major and minor complications, follow up and ultimate outcome.

RESULT: Total numbers of cases are 17. Accidental penetration occurred in 6 cases and rest of the cases were the result of violence. Weapons that were found in this series were: teta-4, dao-3, bamboo stick-3, metallic rod-2, knife-2, sharp stone-1, steam chamber cover (metallic)-1 and long peg-1. On admission GCS was 13-15 in 15 cases. There was no limb weakness in any patient except one. One sided vision loss were present in four cases of orbito-cranial penetrating injury among which one patient expired. Foreign body was in situ in 14 cases that were removed surgically. CT scan and plain X- ray of head were done in all cases. Out of 4 orbito-cranial injury cases orbital evisceration were done in two cases. Post operatively two patients (11.7%) needed ICU support but they died in early postoperative days (PODs). In one case, late osteomyelitis was developed. Rest of the patients are doing well till last follow up.

CONCLUSION: The presenting picture of non-missile penetrating injury to head may be very apprehending but these cases can be managed with very good result by proper (clinical and radiological) evaluation and simple neurosurgical techniques.

Copyright © 2016 Elsevier Inc. All rights reserved.

Language: en