Amirjamshidi A, Abbassioun K, Roosbeh H
Department of Neurosurgery, Sina Hospital, Tehran, Iran.
Surg Neurol. 1997 Apr;47(4):331-8. doi: 10.1016/s0090-3019(96)00357-6.
Air-gun pellet injuries (AgPI) of the central nervous system (CNS) are rare but catastrophic events. They occur mostly in children and young adults. The entrance is usually either through the orbit or through the neck and the entry wound is so small that it may be disregarded on physical examination in the emergency room. Early recognition and correct management of the possible complications of AgPIs is important and may prevent a poor outcome. METHODS We intend to present our experience with 16 cases of AgPIs of the head and neck referred to the department of neurosurgery during the last 15 years. The characteristic findings on physical examination of the cases and the imaging studies performed are described. Special management undertaken for the rare complications are mentioned and a short literature review is performed on each entity. RESULTS All our cases happened in the first and second decades of life and only in boys playing with toy guns. There were 12 head and face and four neck wounds. Damaged globe that had to be exenterated was the earliest complication, handled by ophthalmologists (four cases). Cerebrospinal fluid (CSF) leakage, meningitis, brain abscess formation, development of traumatic aneurysm (TA), carotid-cavernous sinus fistula (CCF), wandering intracerebral and intraventricular pellet, and splitting of the pellet after striking hard bone were the complications noted. In addition to plain X-ray films, computed tomography (CT) scanning and angiography were diagnostic procedures of choice. CONCLUSIONS The present series of patients is the largest collection of AgPIs to the head and neck reported in the literature in which nearly all the possible complications of such injuries have been reviewed. Early recognition and awareness of the possible cumbersome complications of such a minor penetrating wound can prevent major catastrophies in this young group of victims.
中枢神经系统气枪子弹伤（AgPI）虽罕见但后果严重。此类损伤多发生于儿童和青年。受伤入口通常在眼眶或颈部，且入口创口极小，在急诊室体格检查时可能被忽略。尽早识别并正确处理AgPI可能出现的并发症很重要，可避免不良后果。方法：我们旨在介绍过去15年中神经外科收治的16例头颈部AgPI的治疗经验。描述了这些病例的体格检查特征性发现及所进行的影像学检查。提及了针对罕见并发症采取的特殊处理措施，并对每个病例进行了简短的文献综述。结果：我们所有病例均发生在10至20岁，且仅见于玩玩具枪的男孩。有12例头面部伤和4例颈部伤。最早出现的并发症是必须行眼球摘除术的眼球损伤，由眼科医生处理（4例）。还发现了脑脊液（CSF）漏、脑膜炎、脑脓肿形成、创伤性动脉瘤（TA）形成、颈内动脉海绵窦瘘（CCF）、脑内及脑室内游走子弹以及子弹撞击硬骨后裂开等并发症。除普通X线片外，计算机断层扫描（CT）及血管造影是首选的诊断方法。结论：本系列患者是文献报道中头颈部AgPI病例的最大集合，几乎涵盖了此类损伤所有可能的并发症。对于这样一处轻微穿透伤可能出现的棘手并发症，早期识别并提高警惕，可防止这群年轻受害者发生重大灾难。
