Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.

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Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head.

World Neurosurg. 2017 May 19;:

Authors: Turco L, Cornell DL, Phillips B

Abstract
BACKGROUND: Head injuries that cross midline structures of the brain are 'bihemispheric.' Other terms have been used to describe such injuries, but 'bihemispheric' is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with higher mortality and morbidity than other penetrating traumatic brain injuries (TBI). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head non-operatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI.
METHODS: PubMed was searched for query terms and PRISMA guidelines were utilized. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded.
RESULTS: Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had higher mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with higher rates of bihemispheric injuries.
CONCLUSION: Bihemispheric injuries have higher mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. While bihemispheric injuries have historically been considered non-salvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.

PMID: 28532914 [PubMed - as supplied by publisher]

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