Abstract
Background
Penetrating head injuries with impacted foreign bodies are rare, associated with a high incidence of morbidity and potentially life-threatening. In this study, we aimed at investigating the outcome of these cases as well as analyzing the factors affecting the prognosis.
Methods
A retrospective study in which the records of 16 patients who had penetrating head injuries caused by low-velocity impacted foreign bodies were revised. All patients were males with a mean age of 28.9 years (range, 18 to 50 years). The follow-up period ranged from 4 to 13 months with a mean of 8.1 months. Causes of injury were construction accidents in 6 (37.5 %) patients, assault in 6 (37.5 %) and road traffic accidents in 4 (25 %). The impacted objects included a bar of iron, a piece of wood, a nail, a sickle and a piece of glass. Diagnostic computerized tomography (CT) of the brain was carried out on admission in all patients. Thirteen (81.3 %) patients were submitted to surgery, and all had the appropriate management in the form of antibiotics and dehydrating measures as required. The primary outcome measure was the Glasgow Outcome Scale (GOS) at the end of follow-up.
Results
At the end of follow-up, ten (62.5 %) patients had a GOS score of 5, two (12.5 %) patients had a score of 4, and four (25 %) patients had a score of 1.
Conclusions
Low-velocity penetrating head injuries are most common in young adult males. With the appropriate management, a majority of even the most severe cases can have a favorable outcome.
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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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Comment
I read with interest this nice paper. Although there is no surprisingly novel information in the manuscript, the authors present well-illustrated representative cases, drawing sound conclusions and useful suggestions for their clinical and surgical management.
The rarity of the pathology constitutes both the weakness and the strength of this paper.
Scientifically, as the authors themselves admit, the small number of patients included limits the value of the report.
However, the heuristic value of this series and the information provided to the Acta's readers, usually not exposed to this kind of injury, makes this paper worth sharing with the neurosurgical community.
Domenico d'Avella
Padova, Italy
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Moussa, W.M.M., Abbas, M. Management and outcome of low velocity penetrating head injury caused by impacted foreign bodies. Acta Neurochir 158, 895–904 (2016). https://doi.org/10.1007/s00701-016-2764-x
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DOI: https://doi.org/10.1007/s00701-016-2764-x