Intracranial hematomas associated with penetrating wounds of the brain.

Abstract

HIS presentation is a study of a consecutive series of 316 penetrating wounds of the brain with particular reference to the occurrence of intracranial hematomas. The data were made available through the concerted effort of the Medical Officers who were for varying lengths of time associated with an Army Mobile Neurosurgical Unit in Korea3 This unit was attached to a Mobile Army Surgical Hospital, the most forward medical institution offering major surgical facilities. The period represented is from October 13, 1951 through October 31,195~. The report is composed entirely of cases in which operation was performed. By way of definition, any compound wound with entry into the cranial vault and laceration of the meninges, regardless of the severity or extent of cerebral destruction, is considered as a penetrating wound of the brain. This is intended as a broad classification, embracing the through-and-thro ugh wounds and other such descriptive terms as tangential wounds of the brain. The conventional and generally accepted terms are used in the classification of the hematomas. The subcortical or intracerebral hematomas in this series refer, in general, to hematomas of the missile canal resulting from laceration of vascular radicles in the path of the missile. When a hematoma was found to occupy the ventricular cavity, out of particular interest, this was classified as an intraventricular hematoma. Direct visualization of the hematoma was the criterion for this diagnosis and in all instances the penetration traversed the ventricular system. It should be stated that an effort was made to differentiate between a hematoma and a few small clots. It is admittedly difficult to conceive that a missile could penetrate the cerebral substance without provoking some small amount of hemorrhage. Of assistance was the impression gained at operation as to the actual degree of space occupancy. As a rule following sufficient exposure, the hematoma forcefully extruded from its confines. On the contrary, with avulsive wounds of the head and brain occasionally large hematomas were found; however, they were not confined and therefore were not considered as intracranial hematomas in this series. A confined hematoma in excess of ~0 cc. was felt to be of clinical significance and was used as a criterion for the diagnosis of hematoma.