Citation

Di Rita A, Giacalone M, Peraio S, Salomi F, Nucci A, Genitori L, Giordano F. Pediatr. Neurosurg. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Karger Publishers)

DOI

10.1159/000520956

PMID

34823255

Abstract

INTRODUCTION: Although still considered quite harmless, non-powder guns (NPG) may cause severe head injuries in children. We present the case of a depressed skull fracture with superior sagittal sinus involvement following NPG injury. Decision making and surgical management are discussed and current literature concerning NPG-related pediatric head injuries is reviewed. CASE PRESENTATION: A 4-years old boy hit by a compressed-air rifle came to our Centre. CT scan showed a depressed skull fracture of the occipital bone on the midline and intracranial penetration of some fragments of the pellet. CT angiography documented a compression of the superior sagittal sinus without thrombosis. Soon after hospital admission, the patient showed deterioration of the neurological status suggesting intracranial hypertension. Surgery was performed with fracture elevation, removal of metal fragments and wound debridement. The patient had a full recovery without subsequent neurological deficits.

DISCUSSION/CONCLUSION: Modern airguns may produce severe penetrating head injuries in children. Parents and physicians should be aware of the danger of NPG. Depressed skull fracture and dural venous sinus involvement can occur and even a stable neurological condition may worsen. In such instances, a thorough preoperative assessment including vascular imaging is mandatory. The surgical risk is not negligible, due to the possible injury of the sinus wall and subsequent intraoperative bleeding. This has to be weighted against potential complications of the penetrating injury, such as infection, sinus thrombosis and intracranial hypertension. Our case suggests that prompt surgical treatment can be a safe and effective option.

Language: en