title: Image-guided neurosurgery for secondary operative removal of projectiles after missile injury of the brain.
abstract: BACKGROUND
  The primary treatment of penetrating missile injuries of the brain includes debridement of the scalp, fractured skull, and necrotic brain parenchyma. It is acceptable to remove all bony and metallic fragments that are accessible without additional trauma to nondamaged brain regions. Therefore, bone chips and bullets are often initially retained in the brain and are supposedly responsible for delayed cerebral infections and posttraumatic seizures.
  
  
  METHODS
  We successfully operated on 3 patients electively to remove bony and metallic fragments secondarily after penetrating brain trauma. We used an electromagnetic neuronavigation system for preoperative planning and chose a less invasive approach for the exact intraoperative localization of the fragments.
  
  
  RESULTS
  All fragments were extracted without any problems. No patients had any additional neurologic deficits, and no signs of cerebral infections or seizures occurred between 4 and 8 weeks after the operative revision.
  
  
  CONCLUSIONS
  We recommend the implementation of neuronavigation techniques into the surgical strategy for secondary removal of retained missile fragments.
authors.affiliation: Department of Neurosurgery, German Armed Forces Central Hospital, Ruebenacherstrasse 170, 56072 Koblenz, Germany. chr74@gmx.de
authors.forename: Chris
authors.initials: C
authors.lastname: Schulz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Woerner
authors.forename: Peter
authors.initials: P
authors.lastname: Luelsdorf
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000601:surgery*; D005547:Foreign Bodies / Q000601:surgery*; D020197:Head Injuries, Penetrating / Q000601:surgery*; D006801:Humans; D008297:Male; D038361:Neuronavigation; D012086:Reoperation