Civilian nonmissile penetrating brain injury

Abstract

Background: Civilian nonmissile penetrating brain injuries (CNPBIs) have specific characteristic features that are different from missile injuries. Our study presents our experiences on the characteristic features as well as management of such patients. Materials and Methods: We have retrospectively reviewed 11 consecutive patients with CNPBI, having only anterior skull base injury, managed in our institute during 4-year period. The mechanism of injury, clinical investigations, and complications were analyzed with more emphasis on diagnostic and treatment regimen. Results: The 11 cases included in our study comprised 10 males and 1 female. Majority (72.7%) of the patients were adults with a mean age of 27.5 years. The mechanisms of injury often include accidental fall, either onto a small-diameter sharp object (5 cases) or while carrying such an object in hand (2 cases). Other mechanisms were stabbing and accidental. Clinical manifestations included periorbital hematoma (10 cases, 45.5%) and cerebrospinal fluid rhinorrhea or orbitorrhea (4 cases, 18.2%) as well as signs of embedded foreign object (8 cases, 36.4%). We performed emergency craniotomy in 10 cases and skin debridement in 1 case. Postoperative complications were abscess (1 case), seizure (1 case), and traumatic carotid-cavernous fistula (1 case). Conclusion: Nonmissile civilian injuries are generally on the rise and therefore deserve more attention. We observed that clinical outcomes were excellent in 7 (Glasgow Outcome Scale (GOS) of 5) and good in the remaining 4 (GOS of 4) during 6 months–4 years (mean: 2.3 years) follow-up.