Guillen Arguello Roboan, McCarty Patrick J, Brown Merritt, Ponce Mejia Luciano, Culicchia Frank, Roberts Oritsejolomi A, Volk Jerome
1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans.
2Department of Pediatric Neurosurgery, Children's Hospital of New Orleans; and.
J Neurosurg Pediatr. 2025 Apr 18;36(1):65-74. doi: 10.3171/2025.1.PEDS24509. Print 2025 Jul 1.
Firearm injuries are now the leading cause of death in children and adults younger than 25 years in the United States and are associated with high morbidity and mortality. However, literature on penetrating cerebrovascular injuries (PCVIs) after intracranial gunshot wound (GSW) injury in the pediatric population is limited. The authors investigated the incidence, radiological characteristics, and clinical outcomes associated with PCVI in children and young adults with intracranial GSW injuries.
This was a retrospective cohort study of patients younger than 21 years admitted with an intracranial GSW from August 2012 to December 2022 at a single, metropolitan, level I trauma center. Univariate and multivariate logistic regression models were used.
A total of 147 patients presented with intracranial GSW injuries. A cohort of 96 patients (65.3%) met the inclusion criteria, of which 38 (39.6%) underwent vascular cranial imaging and were included in the analysis. The median age was 18 years (range 1-21 years), with 29 (76.3%) males and 9 (23.7%) females. The incidence of PCVI in this cohort was 44.7% (17/38), with an inpatient mortality of 47.1%. A total of 22 vascular injuries (19 [86.4%] arterial, 3 [13.6%] venous) were identified on vascular imaging, including 7 pseudoaneurysms (31.8%), 7 occlusions (31.8%), 5 transections (22.7%), 2 dissections (9.1%), and 2 arteriovenous fistulas (AVFs) (9.1%). Thirteen of 38 patients (34.2%) underwent both CT angiography (CTA) and digital subtraction angiography (DSA) during admission, and 3 of 13 (23.1%) had results that were negative on screening CTA but positive on DSA for PCVI. Patients with PCVI had twice the mortality rate compared with those without (47.1% vs 23.8%, p = 0.133). Patients without PCVI were more likely to have a favorable functional outcome (Glascow Outcome Scale score ≥ 4) compared with those with PCVI (76.2% vs 41.2%, p = 0.028). Multivariate logistic regression, adjusting for age and admission GCS score, showed injury to ≥ 3 lobes was independently associated with PCVI (adjusted OR 6.2, 95% CI 1.05-36.6, p = 0.044).
PCVI occurred in nearly half (44.7%) of children and young adults with intracranial GSW injuries who underwent vascular imaging. PCVI could have a negative impact on functional outcomes in survivors. Early screening, repeat vascular imaging, and informed management are essential to improve outcomes.
在美国，火器伤现已成为儿童及25岁以下成年人死亡的首要原因，且与高发病率和高死亡率相关。然而，关于儿科人群颅内枪伤（GSW）后穿透性脑血管损伤（PCVI）的文献有限。作者调查了颅内GSW损伤的儿童和青年中与PCVI相关的发病率、放射学特征及临床结局。
这是一项对2012年8月至2022年12月在一家大都市一级创伤中心收治的21岁以下颅内GSW患者的回顾性队列研究。使用单因素和多因素逻辑回归模型。
共有147例患者出现颅内GSW损伤。一组96例患者（65.3%）符合纳入标准，其中38例（39.6%）接受了血管颅脑成像并纳入分析。中位年龄为18岁（范围1 - 21岁），男性29例（76.3%），女性9例（23.7%）。该队列中PCVI的发生率为44.7%（17/38），住院死亡率为47.1%。血管成像共发现22处血管损伤（19处[86.4%]动脉损伤，3处[13.6%]静脉损伤），包括7处假性动脉瘤（31.8%）、7处闭塞（31.8%）、5处横断（22.7%）、2处夹层（9.1%）和2处动静脉瘘（AVF）（9.1%）。38例患者中有13例（34.2%）在入院期间接受了CT血管造影（CTA）和数字减影血管造影（DSA），其中13例中有3例（23.1%）筛查CTA结果为阴性，但DSA对PCVI为阳性。与无PCVI的患者相比，有PCVI的患者死亡率高出两倍（47.1%对23.8%，p = 0.133）。与有PCVI的患者相比，无PCVI的患者更有可能获得良好的功能结局（格拉斯哥结局量表评分≥4）（76.2%对41.2%，p = 0.028）。多因素逻辑回归分析，校正年龄和入院时GCS评分后，显示≥3个脑叶损伤与PCVI独立相关（校正OR 6.2，95%CI 1.05 - 36.6，p = 0.044）。
在接受血管成像的颅内GSW损伤的儿童和青年中，近一半（44.7%）发生了PCVI。PCVI可能对幸存者的功能结局产生负面影响。早期筛查、重复血管成像和明智的管理对于改善结局至关重要。
