Rapp L G, Arce C A, McKenzie R, Darmody W R, Guyot D R, Michael D B
Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA.
Neurol Res. 1999 Jul;21(5):475-80.
Migration of retained bullets or bullet fragments may present as a complication of gunshot wounds to the head. This phenomenon has been reported in cases of abscess formation or retained copper fragments. Management of such migratory fragments is controversial. The purpose of this study is to determine the incidence of fragment migration in a population of neurosurgical patients treated for gunshot wounds to the head. Two-hundred and thirteen cases treated at Detroit Receiving Hospital between 1985 and 1987 were reviewed. Each patient treated had initial and one week follow-up imaging studies. Nine cases of documented migratory intracranial bullet fragments were identified. Thus, the incidence in this population is 4.2%. The fragments in eight cases were composed of copper, and in the remaining case, lead. No case was associated with an abscess. Fragments in the anterior fossa were found to migrate towards the sella turcica, while those of the middle fossa and posterior hemispheres migrate towards the confluence of sinuses (Torcula Herophili). Fragment migration was documented as early as 36 h post-injury. Based on this study, we recommend serial imaging studies to look for migrating bullet fragments and surgical removal aided by intra-operative ultrasound to localize the fragment when possible.
留存子弹或子弹碎片的迁移可能是头部枪伤的一种并发症。这种现象在脓肿形成或留存铜质碎片的病例中已有报道。对于此类迁移碎片的处理存在争议。本研究的目的是确定在接受头部枪伤治疗的神经外科患者群体中碎片迁移的发生率。回顾了1985年至1987年间在底特律接收医院治疗的213例病例。每位接受治疗的患者均进行了初始及一周后的影像学检查。确定了9例有记录的颅内子弹碎片迁移病例。因此，该群体中的发生率为4.2%。8例中的碎片由铜组成，其余1例由铅组成。无一例与脓肿相关。发现前颅窝的碎片向蝶鞍迁移，而中颅窝和后半球的碎片则向窦汇（窦汇）迁移。碎片迁移最早在受伤后36小时被记录。基于本研究，我们建议进行系列影像学检查以寻找迁移的子弹碎片，并在可能的情况下借助术中超声定位碎片以协助手术取出。
