Skull Base Reconstruction and Treatment of Cranial and Cerebrovascular Injuries Due to Gunshot Wounds: Outcomes and Experience from a Level 1 Trauma Center

Background: Gun-shot wounds (GSW) to the head can lead to devastating cranial and cerebrovascular injuries needing extensive skull base repair and reconstruction. Reports on the extent of skull base injuries and reconstruction needed after GSWs to the head are rare.

Methods: We reviewed our institutional skull base database to identify all GSW injuries to the head that underwent treatment between 2019 and 2023. Demographic, clinical, radiographic, and treatment outcomes data were analyzed.

Results: Out of 994 cerebrovascular and skull base operations between 2019 and 2023, four cases of GSW to the head were treated (incidence = 0.40%). The mean age was 32 years (range: 16–44 years) and 50% patients were females. Mechanical injuries to the cranial bone and neurovascular structures were seen in all four patients. Thermal injury causing pseudoaneurysm of the middle cerebral artery was seen in one case. The bullet entry wound involved the frontal and orbital bone in 75% (3/4) of the cases. Two patients underwent lobectomy to resect the contused brain (one frontal lobectomy and one temporal lobectomy) and required multiple staged surgeries. One patient underwent an initial decompressive craniectomy and temporal lobectomy followed by re-exploration to remove bullet fragments and cranioplasty a month later. The other patient underwent an initial extensive decompressive craniotomy 3 weeks later by a radial artery graft bypass from the external carotid artery to the middle cerebral artery (MCA) to treat a bullet-induced M2 MCA pseudoaneurysm, followed a week later by re-exploration to remove multiple bone fragments and frontal lobectomy. One patient died (mortality 25%).

Conclusion: Treatment of GSWs to the head can require multiple staged surgeries. Outcomes are highly dependent on the trajectory of the bullet, involvement of critical brain structures, and the time to surgery.

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Artikel online veröffentlicht:
07. Februar 2025