Cargando…

A Case-Based Review of the Management of Penetrating Brain Trauma

Principles of penetrating head trauma management were established by Harvey Cushing in relation to the management of penetrating brain injuries of World War One. Cushing radically debrided the scalp and skull and aggressively irrigated wound tracks to remove foreign bodies. He would then obtain wate...

Descripción completa

Detalles Bibliográficos
Autores principales: Milton, Jason, Rugino, Alex, Narayan, Kailash, Karas, Chris, Awuor, Victor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507758/
https://www.ncbi.nlm.nih.gov/pubmed/28706766
http://dx.doi.org/10.7759/cureus.1342
_version_ 1783249773759823872
author Milton, Jason
Rugino, Alex
Narayan, Kailash
Karas, Chris
Awuor, Victor
author_facet Milton, Jason
Rugino, Alex
Narayan, Kailash
Karas, Chris
Awuor, Victor
author_sort Milton, Jason
collection PubMed
description Principles of penetrating head trauma management were established by Harvey Cushing in relation to the management of penetrating brain injuries of World War One. Cushing radically debrided the scalp and skull and aggressively irrigated wound tracks to remove foreign bodies. He would then obtain water-tight closure. Cushing significantly decreased infection rates which reportedly limited the major cause of mortality due to penetrating head injuries. Many advances have been made by contributions from World War Two, Korean War, Vietnam War, and Iran/Iraq conflicts. Early radical decompression, with conservative debridement and duraplasty applied to blast-induced penetrating injuries during Operation Iraqi Freedom, has resulted in increased survivability and neurological improvement. Each advance in the management of these injuries is based upon more effectively addressing one or more components of Matson’s tenets. This case series reviews the successful management of three patients that presented to a level I trauma center with a penetrating head injury from high-velocity projectiles. Management principles of each patient begin with a proper patient assessment, application of Matson’s tenets from the time of injury, and airway control. Surgical management is based upon adherence to Grahm’s Guidelines which emphasize criteria centered upon post-resuscitative Glasgow Coma Scale score and appropriate imaging. This case series suggests that proper patient evaluation, adherence to Matson’s tenets and to Grahm’s Guidelines, and appropriate patient selection for operative management leads to improved survival of patients with penetrating head trauma from high-velocity projectiles.
format Online
Article
Text
id pubmed-5507758
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-55077582017-07-13 A Case-Based Review of the Management of Penetrating Brain Trauma Milton, Jason Rugino, Alex Narayan, Kailash Karas, Chris Awuor, Victor Cureus Neurosurgery Principles of penetrating head trauma management were established by Harvey Cushing in relation to the management of penetrating brain injuries of World War One. Cushing radically debrided the scalp and skull and aggressively irrigated wound tracks to remove foreign bodies. He would then obtain water-tight closure. Cushing significantly decreased infection rates which reportedly limited the major cause of mortality due to penetrating head injuries. Many advances have been made by contributions from World War Two, Korean War, Vietnam War, and Iran/Iraq conflicts. Early radical decompression, with conservative debridement and duraplasty applied to blast-induced penetrating injuries during Operation Iraqi Freedom, has resulted in increased survivability and neurological improvement. Each advance in the management of these injuries is based upon more effectively addressing one or more components of Matson’s tenets. This case series reviews the successful management of three patients that presented to a level I trauma center with a penetrating head injury from high-velocity projectiles. Management principles of each patient begin with a proper patient assessment, application of Matson’s tenets from the time of injury, and airway control. Surgical management is based upon adherence to Grahm’s Guidelines which emphasize criteria centered upon post-resuscitative Glasgow Coma Scale score and appropriate imaging. This case series suggests that proper patient evaluation, adherence to Matson’s tenets and to Grahm’s Guidelines, and appropriate patient selection for operative management leads to improved survival of patients with penetrating head trauma from high-velocity projectiles. Cureus 2017-06-12 /pmc/articles/PMC5507758/ /pubmed/28706766 http://dx.doi.org/10.7759/cureus.1342 Text en Copyright © 2017, Milton et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurosurgery
Milton, Jason
Rugino, Alex
Narayan, Kailash
Karas, Chris
Awuor, Victor
A Case-Based Review of the Management of Penetrating Brain Trauma
title A Case-Based Review of the Management of Penetrating Brain Trauma
title_full A Case-Based Review of the Management of Penetrating Brain Trauma
title_fullStr A Case-Based Review of the Management of Penetrating Brain Trauma
title_full_unstemmed A Case-Based Review of the Management of Penetrating Brain Trauma
title_short A Case-Based Review of the Management of Penetrating Brain Trauma
title_sort case-based review of the management of penetrating brain trauma
topic Neurosurgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507758/
https://www.ncbi.nlm.nih.gov/pubmed/28706766
http://dx.doi.org/10.7759/cureus.1342
work_keys_str_mv AT miltonjason acasebasedreviewofthemanagementofpenetratingbraintrauma
AT ruginoalex acasebasedreviewofthemanagementofpenetratingbraintrauma
AT narayankailash acasebasedreviewofthemanagementofpenetratingbraintrauma
AT karaschris acasebasedreviewofthemanagementofpenetratingbraintrauma
AT awuorvictor acasebasedreviewofthemanagementofpenetratingbraintrauma
AT miltonjason casebasedreviewofthemanagementofpenetratingbraintrauma
AT ruginoalex casebasedreviewofthemanagementofpenetratingbraintrauma
AT narayankailash casebasedreviewofthemanagementofpenetratingbraintrauma
AT karaschris casebasedreviewofthemanagementofpenetratingbraintrauma
AT awuorvictor casebasedreviewofthemanagementofpenetratingbraintrauma