Skip to main content

Management of Ballistic Trauma to the Head

  • Chapter
  • First Online:
Ryan's Ballistic Trauma

Abstract

Historically, the vast majority of penetrating head injuries (PHI) resulted from military combat operations; however, during the latter part of the twentieth century, these injuries have increased in incidence in civilian trauma centers. The difference in military and civilian PHI is often the nature of the penetrating projectile. In a combat situation, a majority of penetrating missile wounds are from either explosive munitions producing low-velocity fragmentation injuries or high-velocity bullets fired from various ranges.1

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 269.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Berman JM, Butterworth JF, Prough DS. Neurological injuries. In: Zajtchuk R, Bellamy RF, eds. Textbook of Military Medicine, vol. 1. Washington: Office of the Surgeon General; 1995:375-424.

    Google Scholar 

  2. Shaffrey ME, Polin RS, Phillips CD, Germanson T, Shaffrey CI, Jane JA. Classification of civilian craniocerebral gunshot wounds: A multivariate analysis predictive of mortality. J Neurotrauma. 1992;9(Suppl 1):S279-S285.

    PubMed  Google Scholar 

  3. Cooper P. Gunshot wounds of the brain. In: Cooper P, ed. Head Injury. 2nd ed. Baltimore, MD: Williams and Wilkins; 1987:313-326.

    Google Scholar 

  4. Sosin D, Sacks J, Smith S. Head injury associated deaths in the United States from 1979–1986. JAMA. 1989;262L:2251-2255.

    Article  Google Scholar 

  5. West CGH. A short history of the management of penetrating missile injuries of the head. Surg Neurol. 1981;16:145-149.

    Article  PubMed  CAS  Google Scholar 

  6. Schmidek S. Operative neurosurgical techniques. Section 2, Chapter 7: Penetrating Brain Injuries.. Orlando, FL. Grune & Stratton 1988.

    Google Scholar 

  7. Cushing H. Notes on penetrating wounds of the brain. Brit Med J. 1918;221–226

    Google Scholar 

  8. Cushing H. A study of a series of wounds involving the brain and its enveloping structures. Br J Surg. 1918;5:558-684.

    Article  Google Scholar 

  9. Tilney NL. The marrow of tragedy. Surg Gynecol Obstet. 1983;157:380-388.

    PubMed  CAS  Google Scholar 

  10. Matson DD. The Treatment of Acute Craniocerebral Injuries Due to Missiles. Springfield, IL: Charles C Thomas; 1948.

    Google Scholar 

  11. War Surgery Supplement. Br J Surg. 1947;34(137).

    Google Scholar 

  12. Lewin W, Gibson MR. Missile head wounds in the Korean campaign: A survey of British casualties. Br J Surg. 1956;43:628-632.

    Article  PubMed  CAS  Google Scholar 

  13. Carey ME, Young HF, Mathis JL. The neurosurgical treatment of craniocerebra missile wounds in Vietnam. Surg Gynecol Obstet. 1972;135:386-390.

    PubMed  CAS  Google Scholar 

  14. Brandvold B, Levi L, Feinsod M, George E. Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict, 1982–1985. J Neurosurg. 1990;72:15-21.

    Article  PubMed  CAS  Google Scholar 

  15. Ordog GJ. Wound ballistics: Theory and practice. Ann Emerg Med. 1984;13(12):1113-1122.

    Article  PubMed  CAS  Google Scholar 

  16. Barach E, Tomlanovich M, Nowak R. Ballistics: A pathophysiologic examination of the wounding mechanisms of firearm: part 1. J Trauma. 1986;26(3):225-235.

    Article  PubMed  CAS  Google Scholar 

  17. Sykes LN, Champion HR, Fouty WJ. Dum-dums, hollow-points, and devastors: Techniques designed to increase wounding potential of bullets. J Trauma. 1988;28(5):618-623.

    Article  PubMed  Google Scholar 

  18. Grahm T, Williams F Jr, Harrington T, Spetzler R. Civilian gunshot wounds to the head: A prospective study. Neurosurgery. 1990;27:696-700.

    Article  PubMed  CAS  Google Scholar 

  19. Kauffman HH, Makela ME, Lee KF, Haid RW Jr, Gildenberg PL. Gunshot wounds to the head: A perspective. Neurosurgery. 1986;18:689-695.

    Article  Google Scholar 

  20. Knightly JJ, Pullliam MW. Military head injuries. In: Narayan RK, Willberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw-Hill; 1996:891-902.

    Google Scholar 

  21. Kennedy FR, Gonzalez P, Beitler A, Sterling-Scott R, Fleming AW. Incidence of cervical spine injury in patients with gunshot wounds to the head. South Med J. 1994;87:621-623.

    Article  PubMed  CAS  Google Scholar 

  22. Trask T, Narayan RK. Civilian penetrating head injury. In: Narayan RK, Wilberger JE, Povlishock JT, eds. Neurotrauma. New York: McGraw-Hill; 1996:869-889.

    Google Scholar 

  23. Neuroimaging in the management of penetrating brain injury. J Trauma. 2001;51:S7-S11.

    Google Scholar 

  24. Aarabi B. Management of traumatic aneurysms caused by high-velocity missile head wounds. Neurosurg Clin North Am. 1995;6:775-797.

    CAS  Google Scholar 

  25. Haddad FS, Haddad GF, Taha J. Traumatic intracranial aneurysms caused by missiles: Their presentation and management. Neurosurgery. 1991;28:1-7.

    Article  PubMed  CAS  Google Scholar 

  26. Amirjamshidi A, Rahmat H, Abbassioun K. Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occuring during war: Principles and pitfalls in diagnosis and management. J Neurosurg. 1996;84:769-780.

    Article  PubMed  CAS  Google Scholar 

  27. Oliver C, Kabala J. Air gun pellet injury: The safety of MR imaging. Clin Radiol. 1997;52:299-300.

    Article  PubMed  CAS  Google Scholar 

  28. Smith AS, Hurst GC, Durek JL, Diaz PJ. MR of ballistic materials: Imaging artifacts and potential hazards. Am J Neruoradiol. 1991;12:567-572.

    CAS  Google Scholar 

  29. Teitelbaum GP, Yee CA, Van Horn DD, Kim HS, Colletti PM. Metallic ballistic fragments: MR imaging safety and artifacts. Radiology. 1990;175:855-859.

    PubMed  CAS  Google Scholar 

  30. Crockard HA. Early intracranial pressure studies in gunshot wounds of the brain. J Trauma. 1975;15:339-347.

    Article  PubMed  CAS  Google Scholar 

  31. Lillard PL. Five year experience with penetrating craniocerebral gunshot wounds. Surg Neurol. 1978;9:79-83.

    PubMed  CAS  Google Scholar 

  32. Nagib MG, Rockswold GL, Sherman RS, Lagaard MW. Civilian gunshot wounds to the brain: Prognosis and management. Neurosurgery. 1986;18:533-537.

    Article  PubMed  CAS  Google Scholar 

  33. Sarnaik AP, Kopec J, Moylan P, Alvarez D, Canady A. Role of aggressive intracranial pressure in management of pediatric craniocerebral gunshot wounds with unfavorable features. J Trauma. 1989;29:1424-1437.

    Article  Google Scholar 

  34. Intracranial pressure monitoring in the management of penetrating brain injury. J Trauma. 2001;51:S12-S15.

    Google Scholar 

  35. Bullock R, Chesnut RM, Clifton G, et al. Guidelines for the management of severe head injury. Eur J Ernerg Med. 1996;3:109-127.

    Article  CAS  Google Scholar 

  36. Vascular complications of penetrating brain injury. J Trauma. 2001;51:S26-S28.

    Google Scholar 

  37. Aldrich EF, Eisnberg HM, Saydjari C, et al. Predictors of mortality in severely head-injured patients with civilian gunshot wound: A report from the NIH Traumatic Coma Data Bank. Surg Neurol. 1992;38:418-423.

    Article  PubMed  CAS  Google Scholar 

  38. Levy ML, Rezai A, Masri LS, et al. The significance of subarachnoid hemorrhage after penetrating craniocerebral injury: Correlations with angiography and outcome in civilian population. Neurosurgery. 1993;32:532-540.

    Article  PubMed  CAS  Google Scholar 

  39. Kapp JP, Gielchinsky I. Management of combat wounds of the dural venous sinuses. Surgery. 1972;71:913-917.

    PubMed  CAS  Google Scholar 

  40. Aarabi B. Traumatic aneurysms of brain due to high velocity missile head wounds. Neurosurgery. 1988;22:1056-1063.

    Article  PubMed  CAS  Google Scholar 

  41. Jinkins JR, Dadsetan MR, Sener RN, Desai S, Williams RG. Value of acutephase angiography in the detection of vascular injuries caused by gunshot wounds to the head: Analysis of 12 cases. AJR Am J Roentgenol. 1992;159:365-368.

    PubMed  CAS  Google Scholar 

  42. Caverness WF, Meirowsky AM, Rish BL, et al. The nature of posttraumatic epilepsy. J Neurosurg. 1979;50:545-553.

    Article  Google Scholar 

  43. Salazar AM, Jabbari B, Vance SC, Grafman J, Amin D, Dillon JD. Epilepsy after penetrating head injury, I: Clinical correlates—a report of the Vietnam Head Injury Study. Neurology. 1985;35:1406-1414.

    PubMed  CAS  Google Scholar 

  44. Weiss GH, Salazar AM, Vance SC, Grafman JH, Jabbian B. Predicting posttraumatic epilepsy in penetrating head injury patients. Arch Neurol. 1986;43:771-773.

    PubMed  CAS  Google Scholar 

  45. Antiseizure prophylaxis for penetrating brain injury. J Trauma. 2001;51:241-243.

    Google Scholar 

  46. Thoreby FP, Darlow HM. The mechanism of primary infection of bullet wounds. Br J Surg. 1967;54:359.

    Article  Google Scholar 

  47. Wolf AW. Autosterilization in low-velocity bullets. J Trauma. 1978;18:63.

    Article  PubMed  CAS  Google Scholar 

  48. Taha JM, Saba MI, Brown JA. Missile injuries to the brain treated by simple wound closure: Results of a protocol during the Lebanese conflict. Neurosurgery. 1991;29:380-383.

    Article  PubMed  CAS  Google Scholar 

  49. Taha JM, Haddad FS, Brown JA. Intracranial infection after missile injuries to the brain: Report of 30 cases from the Lebanon conflict. Neurosurgery. 1991;29:864-868.

    Article  PubMed  CAS  Google Scholar 

  50. Surgical management of penetrating brain injury. J Trauma. 2001;51:S16-S25.

    Google Scholar 

  51. Suddaby L, Weir B, Forsyth C. The management of.22 caliber gunshot wounds of the brain: A review of 49 cases. Can J Neurol Sci. 1987;14:268-272.

    PubMed  CAS  Google Scholar 

  52. Arendall REH, Meirowsky AM. Air sinus wounds: an analysis of 163 consecutive cases incurred in the Korean War, 1950–1952. Neurosurgery. 1983;13:377-380.

    Article  PubMed  CAS  Google Scholar 

  53. Kearney TJ, Bentt L, Grode M, Lee S, Hiatt JR, Shabot MM. Coagulopathy and catecholamines in severe head injury. J Trauma. 1992;32:608-612.

    Article  PubMed  CAS  Google Scholar 

  54. Part 2: Prognosis in penetrating brain injury [review]. J Trauma. 2001;51(suppl 2):S44-S86.

    Google Scholar 

  55. BTF Website https://www.braintrauma.org/coma-guidelines.

  56. Marshall LF, Maas AI, Marshall SB, Bricolo A, et al. A mutlicenter trial on the efficacy of using tirilazad mesylatein cases of head injury. J Neurosurg. 1998;89:519-525.

    Article  PubMed  CAS  Google Scholar 

  57. Kaufman HH, Schwab K, Salazar AM. A national survery of neurosurgical care for penetrating head injury. Surg Neurol. 1991:36(5):370-377.

    Google Scholar 

  58. Shoung HM, Sichez JP, Pertuiset B. The early prognosis of craniocerebral gunshot wounds in civilian practice as an aid to the choice of treatment. Acta Neurochir (Wien). 1985;74:27-30.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geoffrey S. F. Ling .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer London

About this chapter

Cite this chapter

Ling, G.S.F., Neal, C.J., Ecklund, J.M. (2011). Management of Ballistic Trauma to the Head. In: Brooks, A., Clasper, J., Midwinter, M., Hodgetts, T., Mahoney, P. (eds) Ryan's Ballistic Trauma. Springer, London. https://doi.org/10.1007/978-1-84882-124-8_24

Download citation

  • DOI: https://doi.org/10.1007/978-1-84882-124-8_24

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-123-1

  • Online ISBN: 978-1-84882-124-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics