Shimura T, Mukai T, Teramoto A, Toda S, Yamamoto Y, Nakamura T, Takatori T, Endo T
Department of Neurosurgery, Nippon Medical School.
No Shinkei Geka. 1997 Jul;25(7):607-12.
Gunshot wounds are rare in Japan because of few regulatory laws against the possession of guns. Nevertheless such wounds are increasing in prevalence these days. Reports on the microscopic findings concerning these intracerebral lesions are fewer than those on the macroscopic findings in the scalp, the skull and the intracranial cavity. In this study we evaluated computed tomographical and histopathological findings in craniocerebral gunshot injuries.
Nine patients with gunshot wounds to the head were presented. All were male and the age ranged from 17 to 66 years. Four were suicides and four were attempted murders and the last one was of unknown etiology. Morphological examination was performed on 5 autopsy cases. The distance of the bullet from the cranial cavity was as follows: long distance, 4 cases; close contiguity, 5 cases. The calibers of the weapons were as follows: 38 mm in 6 cases, 45 mm in 1 case and unknown in 2 cases.
CT scans were examined in six cases, which revealed a missile track, hemorrhagic contusion, traumatic subarachnoid hemorrhage and marked tension pneumocephalus. In some cases, CT scan also revealed bony and metallic fragments, some deep within the cranial cavity. In the histopathological study, we found marked swollen brain (brain weight over 1500 mg) and hemorrhagic contusion in the vicinity of the missile track and interhemispheric fissure, and widespread traumatic subarachnoid hemorrhage and intraventricular hematoma. We would like to emphasize especially the remote contusion seen in the distant part of the missile track as well as massive exsudation and hemorrhage around the nerve fiber bundles. Remote contusion was observed in the inferior surface of the fronto-temporal lobes, and bilateral hemorrhagic contusion was seen in the vicinity of the superior longitudinal fissure on CT scans and autopsy findings. In one case, the bullet rotated within the intracranial cavity. In conclusion, nine cases of craniocerebral gunshot injuries were examined, while we also reviewed the medical literature concerning the shearing injury produced by gunshot brain wounds. The head injuries were further delineated by the correlation between autopsy and computerized tomography findings.
由于日本对枪支持有方面的管制法律较少，枪伤在日本较为罕见。然而，如今此类伤口的发生率正在上升。关于这些脑内损伤微观发现的报告少于头皮、颅骨和颅内宏观发现的报告。在本研究中，我们评估了颅脑枪伤的计算机断层扫描和组织病理学发现。
介绍了9例头部枪伤患者。均为男性，年龄在17至66岁之间。4例为自杀，4例为谋杀未遂，最后1例病因不明。对5例尸检病例进行了形态学检查。子弹距颅腔的距离如下：远距离，4例；紧密相邻，5例。武器口径如下：6例为38毫米，1例为45毫米，2例不明。
对6例进行了CT扫描，显示有弹道、出血性挫伤、外伤性蛛网膜下腔出血和明显的张力性气颅。在某些病例中，CT扫描还显示有骨碎片和金属碎片，有些位于颅腔内深处。在组织病理学研究中，我们发现脑明显肿胀（脑重超过1500毫克），弹道和大脑镰旁有出血性挫伤，广泛的外伤性蛛网膜下腔出血和脑室内血肿。我们尤其要强调在弹道远处看到的远隔挫伤以及神经纤维束周围的大量渗出和出血。在额颞叶下表面观察到远隔挫伤，在CT扫描和尸检结果中，大脑镰上纵裂附近可见双侧出血性挫伤。在1例中，子弹在颅内旋转。总之，检查了9例颅脑枪伤病例，同时我们还回顾了有关枪伤脑损伤所致剪切伤的医学文献。通过尸检和计算机断层扫描结果之间的相关性，进一步明确了头部损伤情况。
