Background: Penetrating non-missile craniocerebral injuries are uncommon civilian injuries which present a significant challenge to neurosurgeons. Only limited case-reports are available in the literature with lack of clear guidelines for initial evaluation, surgical intervention, and postoperative care. Objectives: To present our experience with a series of ten patients with penetrating non-missile craniocerebral injuries and review the literature to provide a neurosurgical perspective regarding diagnosis and treatment of these challenging injuries. Patients and Methods: We present a retrospective review of ten patients with penetrating head injury. We have included only the cases with in situ impacted foreign bodies. Early identification and removal of the impacted foreign bodies was achieved within 6-12 hours. Immediate post-traumatic triple antibiotic therapy was given to all patients. Antiepileptic therapy was given to only three patients with post-traumatic seizures (PTS) . Results: Outcome was excellent in seven cases, one patient showed left sided hemiparesis with good response to physiotherapy. One patient was reoperated for debridement of retained foreign body fragments and two patients suffered prolonged wound discharge and recovered well after treatment. There were no recorded postoperative seizures or cerebrospinal fluid (CSF) leaks. Conclusion: Early diagnosis, prompt surgical intervention with efficient debridement and proper antibiotic regimen are the key factors for improving the outcome of penetrating craniocerebral injuries. |
