Nonmissile penetrating head injuries (NPHIs): surgical management and review of the literature.

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Nonmissile penetrating head injuries (NPHIs): surgical management and review of the literature.

World Neurosurg. 2016 Dec 05;:

Authors: Li XS, Yan J, Liu C, Luo Y, Liao XS, Yu L, Xiao SW

Abstract
BACKGROUND: Nonmissile penetrating head injuries (NPHIs) in the civilian population are rare but with potentially fatal features. While numerous cases have been reported in the literature, the surgical management of such injuries is still ambiguous, especially with surgical techniques updating. Here we will illustrate 5 cases of NPHIs managed with different surgical techniques and review the literature on surgical treatment of these injuries to outline the appropriate management for these patients from neurosurgical perspective.
METHOD: We retrospectively reviewed 5 cases of NPHIs managed surgically in our department. The clinical data were collected including cause, type of objects, way of penetration, initial clinical evaluation, imaging, surgical intervention, postoperative care, complication, follow up and ultimate outcome. In addition, a systematic review of the literature was performed in PubMed database to search articles on surgical treatment of these injuries.
RESULT: These 5 cases were caused by twisted steel bar, electric welding rod and sewing needle, respectively. Preoperative imaging including CT, MRI and DSA was selectively done to assist the operative plan. Foreign objects were removed surgically in all cases. Postoperative prophylactic administration of antibiotics and anticonvlsants was used to prevent infectious and epileptic complications. Most of the patients achieved better outcome except for 1 case.
CONCLUSION: NPHIs are fatal but they can be managed with satisfactory results by proper preoperative imaging evaluation, rapid appropriate surgical management and accurate postoperative care. And the personalized surgical intervention should be undertaken depending on the mechanism and extent of NPHIs.

PMID: 27931948 [PubMed - as supplied by publisher]

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