Journal Article

Current Concepts in Penetrating and Blast Injury to the Central Nervous System

Armonda, Rocco, Rosenfeld, Jeffrey V., Bell, Randy S.

2015

Overview

Aim To review the current management, prognostic factors and outcomes of penetrating and blast injuries to the central nervous system and highlight the differences between gunshot wound, blast injury and stabbing. Methods A review of the current literature was performed. Results Of patients with craniocerebral GSW, 66–90 % die before reaching hospital. Of those who are admitted to hospital, up to 51 % survive. The patient age, GCS, pupil size and reaction, ballistics and CT features are important factors in the decision to operate and in prognostication. Blast injury to the brain is a component of multisystem polytrauma and has become a common injury encountered in war zones and following urban terrorist events. GSW to the spine account for 13–17 % of all gunshot injuries. Conclusions Urgent resuscitation, correction of coagulopathy and early surgery with wide cranial decompression may improve the outcome in selected patients with severe craniocerebral GSW. More limited surgery is undertaken for focal brain injury due to GSW. A non-operative approach may be taken if the clinical status is very poor (GCS 3, fixed dilated pupils) or GCS 4–5 with adverse CT findings or where there is a high likelihood of death or poor outcome. Civilian spinal GSWs are usually stable neurologically and biomechanically and do not require exploration. The indications for exploration are as follows: (1) compressive lesions with partial spinal cord or cauda equina injury, (2) mechanical instability and (3) complications. The principles of management of blast injury to the head and spine are the same as for GSW. Multidisciplinary specialist management is required for these complex injuries.

• Publisher: Springer International Publishing,John Wiley & Sons, Inc
• Subject: Abdominal Surgery / Age Factors / Blast Injuries - complications / Blast Injuries - epidemiology / Blast Injuries - surgery / Brain - diagnostic imaging / Brain Injuries - etiology / Brain Injuries - surgery / Cardiac Surgery / Clinical Decision-Making / Decompression, Surgical / Decompressive Craniectomy / Emergency Medical Services / Emergency Medicine / General Surgery / Glasgow Coma Scale / Glasgow Coma Score / Glasgow Outcome Score / Humans / Medicine / Medicine & Public Health / Minimal Conscious State / Neurosurgical Procedures / Prognosis / Pupil Disorders - diagnosis / Radiography / Spinal Injuries - etiology / Spinal Injuries - surgery / Spinal Injury / Spine - diagnostic imaging / Surgery / Surgical Symposium Contribution / Thoracic Surgery / Traumatology / Vascular Surgery / Wounds, Gunshot - complications / Wounds, Gunshot - epidemiology / Wounds, Gunshot - surgery / Wounds, Stab - complications / Wounds, Stab - epidemiology / Wounds, Stab - surgery