Transcranial brainstem stab injuries: a retrospective analysis of 17 patients.
OBJECTIVE
Transcranial stab injuries remain a frequent cause of emergent neurosurgical admissions to neurosurgical units in South Africa. Brainstem stabs are an uncommon, yet often fatal, form of brain injury.


METHODS
A retrospective audit of 597 patients with transcranial stab injuries admitted to our unit over a 12-year period (January 1987 to December 1998) identified 17 patients (2.85%) with brainstem stab injuries. The computed tomographic scans of all patients were analyzed, and a detailed autopsy examination of the skull and its contents was performed in all patients who died. Stepwise linear regression analysis was used to formulate a predictive model of outcome for the entire series of 597 patients.


RESULTS
The majority of the patients were males (16 patients), and the study group had a mean age of 28.65 +/- 9.59 years and a mean Glasgow Coma Scale score of 8.59 +/- 2.76. Knives (82%) were the most common instruments of penetration. Cerebral angiography identified 3 patients with vascular abnormalities, and autopsy revealed an additional 4 patients with vascular injury. Emergency ventriculostomy was performed in 10 patients for obstructive hydrocephalus. Four of the 17 patients survived (76.5% mortality). Factors significantly predictive of outcome in patients with transcranial stab injuries were the Glasgow Coma Scale score (F = 43.7), the occurrence of intraventricular hemorrhage (F = 22.8), the type of associated lesion (intracranial bleed, vascular abnormality, or brain abscess) (F = 5.9), and the number of operations (F = 3.2).


CONCLUSIONS
The Glasgow Coma Scale score is the most significant predictor of outcome in low-velocity transcranial stab injuries. Brainstem stab injuries have a great propensity for vascular damage. Survivors are incapacitated by severe, fixed neurological deficits.
Nathoo
N
N
Department of Neurosurgery, Wentworth Hospital, School of Clinical Sciences, University of Natal, Durban, South Africa. nathoo@wwh.und.ac.za
Boodhoo
H
H
Nadvi
S S
SS
Naidoo
S R
SR
Gouws
E
E
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D001933:Brain Stem / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D002648:Child; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt; D014951:Wounds, Stab / Q000150:complications / Q000175:diagnosis* / Q000601:surgery