title: Management of nonmissile penetrating brain injuries: a description of three cases and review of the literature.
abstract: Nonmissile penetrating intracranial injuries are uncommon events in modern times. Most reported cases describe trajectories through the orbit, skull base foramina, or areas of thin bone such as the temporal squama. Patients who survive such injuries and come to medical attention often require foreign body removal. Critical neurovascular structures are often damaged or at risk of additional injury resulting in further neurological deterioration, life-threatening hemorrhage, or death. Delayed complications can also be significant and include traumatic pseudoaneurysms, arteriovenous fistulas, vasospasm, cerebrospinal fluid leak, and infection. Despite this, given the rarity of these lesions, there is a paucity of literature describing the management of neurovascular injury and skull base repair in this setting. The authors describe three cases of nonmissile penetrating brain injury and review the pertinent literature to describe the management strategies from a contemporary cerebrovascular and skull base surgery perspective.
authors: Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri.
authors: Justin M
authors: JM
authors: Sweeney
authors: Jonathon J
authors: JJ
authors: Lebovitz
authors: Jorge L
authors: JL
authors: Eller
authors: Jeroen R
authors: JR
authors: Coppens
authors: Richard D
authors: RD
authors: Bucholz
authors: Saleem I
authors: SI
authors: Abdulrauf
keywords: Penetrating trauma; brain; pseudoaneurysm; skull base
references: Neurocirugia (Astur). 2009 Oct;20(5):467-9
references: 19830370
references: Neurosurgery. 1991 Jan;28(1):1-7
references: 1994264
references: Surg Neurol. 1978 Apr;9(4):267
references: 675480
references: Clin Neurol Neurosurg. 2008 Feb;110(2):207-10
references: 17983703
references: Br J Ophthalmol. 1986 Feb;70(2):147-9
references: 3947613
references: J Neurosurg. 2006 May;104(5):828-34
references: 16703892
references: Neurosurgery. 1984 May;14(5):598-600
references: 6728171
references: Pediatr Neurosurg. 2008;44(6):493-5
references: 19066442
references: J Neurosurg. 1980 Jan;52(1):11-20
references: 7350269
references: J Trauma Nurs. 2009 Apr-Jun;16(2):82-6
references: 19543016
references: Acta Neurochir (Wien). 2009 Jun;151(6):685-7
references: 19255713
references: Acta Neurochir (Wien). 2006 Sep;148(9):937-41; discussion 941-2
references: 16763734
references: J Trauma. 2000 Oct;49(4):788
references: 11038107
references: J Pediatr Ophthalmol Strabismus. 1999 Jan-Feb;36(1):44-6
references: 9972516
references: Neurol Med Chir (Tokyo). 2001 Jul;41(7):345-8
references: 11487998
references: Br J Neurosurg. 1999 Apr;13(2):206-11
references: 10616594
references: J Neurosurg. 1964 Dec;21:1095-7
references: 14279830
references: Neurosurg Rev. 2007 Jul;30(3):263-7; discussion 267
references: 17440757
references: J Neurosurg. 1972 May;36(5):531-6
references: 5026539
references: Cardiovasc Intervent Radiol. 2006 Nov-Dec;29(6):958-68
references: 16897263
references: J Neurosurg. 1967 Jun;26(6):636-8
references: 6027450
references: Ulus Travma Acil Cerrahi Derg. 2007 Jul;13(3):241-3
references: 17978902
references: West J Med. 1977 Jan;126(1):1-4
references: 831365
references: J Neurol Neurosurg Psychiatry. 1973 Feb;36(1):127-38
references: 4691685
references: Am J Forensic Med Pathol. 2008 Sep;29(3):268-70
references: 18725787
references: Ann Surg. 1936 Feb;103(2):173-98
references: 17856711
references: J Neurosurg. 1984 Jan;60(1):42-6
references: 6689727
references: J Neuropathol Exp Neurol. 1950 Apr;9(2):139-49
references: 15415757
references: Neurosurgery. 2000 Nov;47(5):1117-22; discussion 1123
references: 11063104
references: Anaesthesist. 2004 Sep;53(9):830-5
references: 15278195
references: Surg Neurol. 1978 Aug;10(2):110-4
references: 705584
references: Neurosurgery. 1993 Apr;32(4):532-40
references: 8474643
references: Injury. 1991 Jan;22(1):29-31
references: 2030026