Diagnosis and treatment of penetrating craniocerebral injury.
OBJECTIVE
To evaluate the clinical characteristics and present the experience in the treatment of patients with penetrating craniocerebral injury (PCCI).


METHODS
The data of 7 cases with PCCI by foreign body were retrospectively studied and compared with associated literatures. The strategies of diagnosis and treatment of PCCI were analyzed. In this series, 3 cases underwent emergency debridements and 4 cases underwent craniotomies. All patients received surgical intervention within 3 hours after admission.


RESULTS
Outcomes were good in 3 cases, moderate disability was in 2 cases, severe disability in 1 case and persistent vegetative state in 1 case. One case developed wound and intracranial infection, but made good recovery after treatment. During the follow-up period, one patient died one month after discharge and other six patients (range from 8 months to 3 years) recovered well and no epilepsy, leakage of cerebrospinal fluid (CSF), or traumatic vascular disease occurred.


CONCLUSIONS
Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of PCCI. CT scans are the mainstay in evaluating PCCI and three dimensional (3D) images reconstructed from spiral CT scans provide more information. Efficient debridement should be performed as early as possible. Minimizing the degree of surgical management of PCCI is preferred when there is no indication for aggressive operation. It is important to stress the rapid and effective management of CSF leakage in early stage of PCCI. Use of prophylactic broad-spectrum antibiotics is recommended for patients with PCCI. Traumatic vascular injury should be paid attention to after PCCI.
Tong
Ying
Y
Department of Neurosurgery, the First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou 310003, China. tongying216@hotmail.com
Xu
Zeng-Bin
ZB
Zhan
Ren-Ya
RY
Liu
Fan-Long
FL
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents; D002648:Child; D002681:China; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000379:methods*; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012494:Sampling Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents