Duddleston Pate J, Gendreau Julian L, Little Kristen A, Andrews Amber, Thompson Willard D
1School of Medicine, Mercer University, Macon; and.
2Neurological and Spine Institute of Savannah, Georgia.
J Neurosurg Pediatr. 2020 Jul 10;26(4):445-448. doi: 10.3171/2020.4.PEDS19606. Print 2020 Oct 1.
Extraction of a bullet fragment seated in deep brain parenchyma utilizing a neuroendoscope has not been previously reported in the literature. The authors report the case of a 4-year-old patient who presented after a pellet gun injury with a projectile located 6 cm intracranially and lodged within the posterior thalamus and near the posterior limb of the internal capsule. Initial operative repair included repair of a CSF leak with duraplasty, minimal brain debridement, and elevation of a depressed skull fracture. Subsequent CT at 2 months postoperatively revealed migration of the deep intracranial pellet. This finding correlated with intermittent worsening neurological symptoms and signs. A rigid 3-mm neuroendoscope with CT stereotactic navigation was then used to remove the pellet fragment from the thalamus. The patient returned home with alleviation of clinical symptoms and an uneventful postoperative recovery. This case demonstrates that navigation-guided neuroendoscopy can be successfully used to remove projectile fragments from deep brain structures, especially when the migration is along the initial path of the bullet. This technique represents another low-risk curative option in the management of retained bullet fragments in gunshot wound injuries to the head.
利用神经内镜取出位于脑实质深部的子弹碎片，此前文献中尚无报道。作者报告了一例4岁患者，该患者因气枪伤就诊，颅内有一枚射弹，位于颅内6 cm处，嵌顿于丘脑后部并靠近内囊后肢。初次手术修复包括用硬脑膜成形术修复脑脊液漏、进行最小限度的脑清创以及抬高凹陷性颅骨骨折。术后2个月的后续CT显示颅内深部弹丸移位。这一发现与间歇性加重的神经症状和体征相关。随后使用带有CT立体定向导航的3毫米硬质神经内镜从丘脑取出弹丸碎片。患者临床症状缓解，术后恢复顺利，回家休养。该病例表明，导航引导下的神经内镜检查可成功用于从深部脑结构中取出射弹碎片，尤其是当碎片沿子弹初始路径移位时。该技术是头部枪伤中残留子弹碎片处理的另一种低风险治疗选择。
