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Management of Gunshot Wounds to the Head 

Management of Gunshot Wounds to the Head
Chapter:
Management of Gunshot Wounds to the Head
Author(s):

Bizhan Aarabi

DOI:
10.1093/med/9780190936259.003.0019
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date: 26 June 2022

In civilian life, gunshot wounds to the head are deadly. Almost 90% of patients will die at the scene, and only 10% have a chance to be seen and treated in a trauma center. The neurosurgeon must first examine the patient and look for overall outcome. Patients with Glasgow Coma Scale (GCS) scores of 5 and less, fix and dilated pupils, and with a slug traversing the sagittal or coronal planes and closed ambient cisterns have a very high chance of death and disability. Patients with good GCS scores and injuries involving air sinuses need special care during surgery and need watertight dural closure. Extensive convexity wounds may need superficial debridement and/or decompressive craniectomy in association with intracranial pressure monitoring. Small BB gun fragments are innocuous and pose very little chance of infection. Fragments involving the orbits, face, and pterion upon entering the brain, crossing the midline, and associated with intracerebral hematomas must have CT angiography to rule out traumatic intracranial aneurysms. Almost 50% of patients with penetrating head injury will eventually become epileptic.

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