Treatment strategy in a child with a retained bullet in the cerebellomedullary cistern.
A 6-year-old girl was admitted to our emergency room because of a gunshot wound in the posterior craniocervical junction. On admission, she was alert, but left hemiplegia and right hemiparesis were noted. Cranial CT scanning showed a retained bullet in the cerebellomedullary cistern without bone destruction. Moreover, fourth ventricle hemorrhage was observed. There were no signs of acute hydrocephalus. The patient underwent suboccipital craniectomy and C-1 laminectomy for bullet removal. Postoperatively, the patient experienced significant neurological improvement. To the best of the authors' knowledge, this is the first documented case of a patient with a retained bullet in the cerebellomedullary cistern. The management strategies in such a unique case are discussed.
Division of Neurosurgery, Andaraí Federal Hospital, Rio de Janeiro, Brazil.
Marcílio Diogo
MD
de Oliveira Barbosa
Thiago
T
de Bellis
Marcelo Sampaio
MS
Pousa
Rodrigo Sodré Calheiros
RS
da Silva
Flávio Assad
FA
Garcia
Marcus André
MA
Acioly
D002543:Cerebral Hemorrhage / Q000209:etiology; D002552:Cerebral Ventricles; D002648:Child; D002946:Cisterna Magna / Q000293:injuries*; D005260:Female; D005547:Foreign Bodies; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*