Clinical and Neurosurgical Management of Cranial Machete Injuries: The Experience of a Tertiary Referral Center in Nicaragua

Abstract

The neurosurgical literature rarely describes managing open head injuries caused by machetes, although this is a common head injury in developing countries. We present our experience managing cranial machete injuries in Nicaragua over a 5-year period. A retrospective chart review identified patients admitted to a neurosurgery service for cranial machete injury. Among 51 patients studied, the majority (n=42, 82%) presented with mild neurologic deficits (Glasgow Coma Scale score ≥14). Nondepressed skull fracture (25/37, 68%) was the most common injury identified on skull radiography, and pneumocephalus (15/29, 52%) was the most common injury identified with computed tomography. Overall, 38 patients (75%) underwent surgical intervention for 1 or more conditions, including laceration length ≥10 cm (n= 20), open intracranial wound (n= 8), pneumocephalus (n= 7), cerebral contusion (n= 6), intracranial hemorrhage (n= 5), and depressed fracture (n= 5). All patients received aggressive antibiotic therapy. Patients without intracranial injury received a 7-day course of intravenous ceftriaxone, followed by a 10-day course of oral ciprofloxacin. Patients with violation of the dura received a 7- to 14-day course of intravenous metronidazole, ceftriaxone, and vancomycin, followed by a 10-day course of oral ciprofloxacin. Postoperative complications included a visible skull defect (n= 6), infection (n= 3), and unspecified neurologic (n= 2) and mixed (n= 1) complications. At discharge, most patients had only minimal disabilities (47/51, 92%). In-hospital mortality rate was zero. An aggressive approach to managing open head injury caused by machete yields good outcomes, with the majority of patients experiencing minimal disability at hospital discharge and a low rate of infection.