Department of Neurosurgery, Shanghai Changzheng Hospital, the Second Military Medical University, Shanghai Neurosurgical Institute, Shanghai, 200003 China.
Department of Hepatic Surgery III, Eastern Hepatobiliary Surgical Hospital, Shanghai, 200438 China.
Mil Med Res. 2017 Aug 17;4:26. doi: 10.1186/s40779-017-0135-4. eCollection 2017.
Craniocerebral gunshot injury refers to a wound caused by a bullet passing through or lodged in brain tissue, resulting in the loss of function of a certain area or other fatal damage to the human brain. Craniocerebral gunshot injury is usually life-threatening and is very common in modern warfare, accounting for the majority of battle casualties. Most of the patients suffer from acute cerebral infarction caused by vascular injury. Lack of early and solid battlefield emergency medical interference adds to the risk of death among the wounded.
We present a 24-year-old man who was shot with a shotgun from a distance of 15 m in an accidental injury. Forty-seven grapeshots were found on his body surface by physical examination. A computed tomography (CT) scan demonstrated large areas of low-density shadows in his right parietal lobe and right temporal lobe with the midline shifting to the left side 2 days later. Afterwards, the patient was transferred to our emergency medical center at Changzheng Hospital in Shanghai. Cranial computed tomography angiography (CTA) showed a high-density shadow in the initial part of the right middle cerebral artery. The branches after the initial part were obliterated. Prompt medical attention and decompressive craniotomy (DC) surgery contributed to the final recovery from cerebral infarction of this patient.
Bullets can penetrate or be lodged in the brain, causing intracranial hypertension. The bullets lodged in the brain can result in stenosis and embolism of a cerebral artery, causing acute cerebral infarction. Combining dura turning-over surgery with DC surgery can not only decrease intracranial pressure, which can increase the blood supply for hypertension-induced vessel stenosis, but also help vessels outside the dura mater grow into ischemic areas of the cerebral cortex. However, this new pattern of surgery needs further support from evidence-based medicine.
颅脑枪弹伤是指子弹穿过或停留在脑组织中所造成的损伤，导致大脑的某一区域功能丧失或对大脑造成其他致命损伤。颅脑枪弹伤通常危及生命，在现代战争中非常常见，占战斗伤员的大多数。大多数患者因血管损伤而发生急性脑梗死。缺乏早期和坚实的战场紧急医疗干预会增加伤员的死亡风险。
我们报告了一例 24 岁男性患者，在一次意外受伤中被距离 15 米远的猎枪射击。体格检查发现其体表有 47 颗散弹。2 天后行颅脑 CT 扫描显示右顶叶和右颞叶有大面积低密度影，中线向左侧移位。随后，患者被转送至上海长征医院急救医疗中心。颅脑 CT 血管造影（CTA）显示右侧大脑中动脉起始部高密度影，起始部后的分支闭塞。及时的医疗关注和减压性颅骨切开术（DC）手术有助于该患者最终从脑梗死中恢复。
子弹可以穿透或停留在大脑中，导致颅内压升高。大脑中嵌入的子弹会导致脑动脉狭窄和栓塞，引起急性脑梗死。将硬脑膜翻转手术与 DC 手术相结合，不仅可以降低颅内压，从而增加高血压引起的血管狭窄的血液供应，还可以帮助硬脑膜外的血管生长到大脑皮层的缺血区。然而，这种新的手术模式需要更多循证医学的支持。
