Di Rita Andrea, Giacalone Martina, Peraio Simone, Salomi Francesco, Nucci Alessia, Genitori Lorenzo, Giordano Flavio
Department of Neurosurgery, Meyer Children's Hospital, Florence, Italy.
Department of Emergency Medicine and Trauma Center, Meyer Children's Hospital, Florence, Italy.
Pediatr Neurosurg. 2022;57(2):133-137. doi: 10.1159/000520956. Epub 2021 Nov 25.
Although still considered quite harmless, nonpowder guns (NPG) may cause severe head injuries in children. We present the case of a depressed skull fracture with superior sagittal sinus involvement following NPG injury. Decision-making and surgical management are discussed, and the current literature concerning NPG-related pediatric head injuries is reviewed.
A 4-year-old boy hit by a compressed-air rifle came to our center. CT scan showed a depressed skull fracture of the occipital bone on the midline and intracranial penetration of some fragments of the pellet. CT angiography documented a compression of the superior sagittal sinus without thrombosis. Soon after hospital admission, the patient showed deterioration of the neurological status suggesting intracranial hypertension. Surgery was performed with fracture elevation, removal of metal fragments, and wound debridement. The patient had a full recovery without subsequent neurological deficits.
DISCUSSION/CONCLUSION: Modern airguns may produce severe penetrating head injuries in children. Parents and physicians should be aware of the danger of NPG. Depressed skull fracture and dural venous sinus involvement can occur, and even a stable neurological condition may worsen. In such instances, a thorough preoperative assessment including vascular imaging is mandatory. The surgical risk is not negligible due to the possible injury of the sinus wall and subsequent intraoperative bleeding. This has to be weighted against potential complications of the penetrating injury, such as infection, sinus thrombosis, and intracranial hypertension. Our case suggests that prompt surgical treatment can be a safe and effective option.
尽管非火药枪（NPG）仍被认为危害较小，但可能会导致儿童严重的头部损伤。我们报告一例非火药枪致伤后颅骨凹陷性骨折并累及上矢状窦的病例。讨论了决策过程和手术治疗方法，并回顾了有关非火药枪相关儿童头部损伤的现有文献。
一名4岁男孩被气步枪击中后前来我院。CT扫描显示枕骨中线处颅骨凹陷性骨折，弹丸碎片有颅内穿透。CT血管造影显示上矢状窦受压但无血栓形成。入院后不久，患者神经状态恶化，提示颅内高压。遂行手术，包括骨折复位、取出金属碎片及伤口清创。患者完全康复，无后续神经功能缺损。
讨论/结论：现代气枪可能会对儿童造成严重的穿透性头部损伤。家长和医生应意识到非火药枪的危险性。可能会发生颅骨凹陷性骨折和硬脑膜静脉窦受累，即使神经状态稳定也可能恶化。在这种情况下，包括血管成像在内的全面术前评估是必不可少的。由于可能损伤窦壁及术中出血，手术风险不可忽视。这必须与穿透性损伤的潜在并发症，如感染、窦血栓形成和颅内高压相权衡。我们的病例表明，及时的手术治疗可能是一种安全有效的选择。
