NEUROSURGICAL TREATMENT FOR GUNSHOT WOUND HEAD TRAUMA

Gunshot Wound Head Trauma | American Association of Neurological Surgeons
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Gunshot wounds lớn the head have become a leading cause of traumatic brain injury (TBI) in many urban areas in the U.S. Due, in part, to lớn a surge in gang violence and overall homicide rates. Other cases involve suicide & unintentional accidents. Suicide-related gunshot wounds to the head are associated with a very high mortality rate và severe disability in the few who survive. There is a greater chance of death & poorer outcome for victims with TBIs caused by self-inflicted gunshot wounds, compared to victims injured by gunshot wounds that are accidental or delivered in an assault. According lớn the Centers for Disease Control & Prevention (CDC), in 2010, firearms were used in nearly 44% of suicide deaths among persons under the age of 25. Additionally, in 2012, firearms were the most commonly used method of suicide among males (56%).
Of all TBIs, 12% are attributed to lớn firearms. In people ages 25-34, firearms are a leading cause of TBI. Gunshot wounds lớn the head are the cause of an estimated 35% of all deaths attributed khổng lồ TBI. Gunshot wounds to the head are fatal about 90% of the time, with many victims dying before arriving to lớn the hospital. For victims who survive the initial trauma, about một nửa die in the emergency room. About 50% of surviving patients will suffer from seizures & require anti-epilepsy medication Gunshot wounds lớn the head survivors need long-term rehabilitation và may or may not be able khổng lồ get back lớn pre-injury functional status.
A wound in which the projectile enters the cranium, but does not exit, is referred lớn as a penetrating wound. An injury in which the projectile enters và exits the cranium is referred to as a perforating wound.

When the projectile itself goes through the brain, there is injury from both the direct penetration of the brain and from transmission of a pressure wave from the high-velocity (greater than 2,000 feet/second) projectile traveling through the brain tissue. Both bleeding & damage from this pressure wave results in brain swelling, which can also lead lớn death.

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A number of factors determine the extent of damage caused by a gunshot wound. These include the caliber of the gun, form size and tốc độ of the bullet, the trajectory & site of the injury. A bullet wound going through the right frontal lobe tip toward the forehead & well above the base of the skull is likely lớn cause relatively mild clinical damage, because it passes through no vital brain tissue or vascular structures. However, a similar bullet passing downward from the left frontal lobe tip toward the temporal lobe and brainstem is likely khổng lồ be devastating, because it passes through eloquent brain tissue và is likely to injure important vascular structures inside the head. A bullet trajectory through key blood vessels in the brain can result in rapidly expanding blood clot in the brain that can critically compress the important brain tissue resulting in immediate death at the scene. If the victim survives the initial insult, the issue becomes the increasing pressure inside the skull.


Gunshot wound head trauma patients are aggressively resuscitated upon initial arrival at the hospital. If blood pressure & oxygenation can be maintained, an urgent CT scan of the head is obtained. The decision to proceed with surgical treatment of the gunshot wound is based on the following factors:

CT scan findings.

If patients are deeply comatose with minimal evidence of brainstem function và without evidence of an intracranial hematoma that might be causing coma, a fatal outcome is nearly certain. If a hematoma is confirmed by CT scan, an emergency craniotomy for clot evacuation, removal of debris và devitalized tissue may be performed. It is common for pressure lớn build up within the skull, so a craniectomy (a procedure in which a large portion of the skull is temporarily removed lớn decrease pressure inside the skull) is also often performed.

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Understanding the trajectory of the bullet path is important in determining prognosis và management. The brain is divided into two hemispheres made up of four lobes each, with each lobe providing different functions. Additionally, there are deeper parts of the brain that house many connections, controlling basic toàn thân and brain functions. The brainstem contains nuclei for cranial nerves needed for basic functions, such as breathing and swallowing. It connects the upper portion, or "thinking" portions of the brain, to lớn the spinal cord. The cerebellum, in the back lower part of the brain, is related to lớn motor coordination.


Outcome is poorer for those with extensive bullet tracts, those that cross the deep midline structures of the brain or those that involve the brainstem. A bullet that damages the patient"s right hemisphere can leave the victim with motor and sensory impairments on the left side & vice versa. Many other functions such as cognition, memory, speech & vision are controlled by both sides of the brain. As a result, damage to lớn one hemisphere can leave a person impaired but still able to perform these functions at some level, depending on which lobes of the brain are damaged.

Because each hemisphere is divided into four lobes, the "best-case scenario" is a more superficial injury limited to one hemisphere và a single lobe, limiting the functional impairments caused by the trauma. The first week or two after trauma is the acute & critical-care stage. After that, the extent và speed of recovery depends on how much tissue was damaged, the degree of swelling, pressure inside the head during the acute stage and the functional consequences of the damage. Intensive rehabilitation may be necessary to help survivors regain some of their functions or khổng lồ adapt khổng lồ permanent deficits. Neurological recovery may require several months or even years.


The bullet entry and/or exit site. The areas of the brain damaged by the trauma. Degree of fragmentation of the bullet. Caliber of the bullet và type of weapon . Range of the gunshot wound (distance between the gun and the victim). Timeliness of receiving proper treatment. The victim’s age and general health. Initial GCS score. Reactivity và dilation state of pupils. Status of brainstem reflexes. Blood pressure. Oxygenation state right after injury.
eMedicine, Ainsworth, C. R. (2020, November 30). Head Trauma: Background, Pathophysiology, Etiology. Medscape. Https://emedicine.medscape.com/article/433855-overview Cranial GunShot Wounds - UCLA Neurosurgery, Los Angeles. (n.d.). UCLA Health. Retrieved May 26, 2021, from https://www.uclahealth.org/neurosurgery/cranial-gunshot-wounds Aarabi, B., Tofighi, B., Kufera, J. A., Hadley, J., Ahn, E. S., Cooper, C., Malik, J. M., Naff, N. J., Chang, L., Radley, M., Kheder, A., và Uscinski, R. H. (2014). Predictors of outcome in civilian gunshot wounds khổng lồ the head. Journal of Neurosurgery, 120(5), 1138–1146. Ecker, R. D., Mulligan, L. P., Dirks, M., Bell, R. S., Severson, M. A., Howard, R. S., & Armonda, R. A. (2011). Outcomes of 33 patients from the wars in Iraq & Afghanistan undergoing bilateral or bicompartmental craniectomy. Journal of Neurosurgery, 115(1), 124–129.

daichiensk.com Patient Pages are edited by neurosurgical professionals. This page has been edited by:

Silky Chotai, MD Khoi D. Than, MD, Fdaichiensk.com

The daichiensk.com does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to lớn serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the daichiensk.com’ Find a Board-certified Neurosurgeon” online tool.

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