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Pediatric intracranial arterial injuries by penetrating gunshot wounds: an institutional experience

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Abstract

Purpose

Pediatric intracranial injuries due to penetrating gunshot wounds are a rare entity that is often fatal. A subset of patients may experience an intracerebral arterial injury; however, literature on the pediatric population is limited. This study analyzes a large institution’s experience with pediatric head gunshot wounds and intracranial arterial injuries.

Methods

All pediatric patients ≤ 18 years of age who presented to our institution with a penetrating gunshot wound from 2008 to 2018 were retrospectively analyzed.

Results

Thirty-seven patients presented with an intracerebral penetrating gunshot injury. There were 18 deaths (49%) in the cohort. A total of 20 patients (54%) had vascular imaging. Of the remaining 17 patients with no vascular imaging, 13 (35%) died before any vascular studies were obtained. Four (20%) of the 20 patients with vascular imaging experienced an intracerebral arterial injury. Three of these 4 patients died before treatment could be administered. One patient with a firearm injury underwent embolization of a distal middle cerebral artery pseudoaneurysm and was discharged home with a Glasgow Outcome Scale score of 5 on follow-up.

Conclusion

Pediatric patients with penetrating intracranial gunshot wounds often die before vascular imaging can be obtained.

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Abbreviations

GSW:

Gunshot wound

References

  1. Friedman J, Hoof M, Smith A, Tatum D, Ibraheem K, Guidry C, Schroll R, Duchesne J, McGrew P (2019) Pediatric firearm incidents: It is time to decrease on-scene mortality. J Trauma Acute Care Surg 86:791–796

    Article  Google Scholar 

  2. O’Neill PJ, Lumpkin MF, Clapp B, Kopelman TR, Matthews MR, Cox JC, Caruso DM, Feiz-Erfan I (2009) Significant pediatric morbidity and mortality from intracranial ballistic injuries caused by nonpowder gunshot wounds. A case series Pediatr Neurosurg 45:205–209

  3. Bratton SL, Dowd MD, Brogan TV, Hegenbarth MA (1997) Serious and fatal air gun injuries: more than meets the eye. Pediatrics 100:609–612

    Article  CAS  Google Scholar 

  4. Scribano PV, Nance M, Reilly P, Sing RF, Selbst SM (1997) Pediatric nonpowder firearm injuries: outcomes in an urban pediatric setting. Pediatrics 100:E5

    Article  CAS  Google Scholar 

  5. Cinar K, Secer M, Alagoz F, Ulutas M, Uckun OM, Yildirim AE, Gurcay AG, Guvenc Y, Celik H, Narin F (2015) Outcomes and demostration of cranial firearm injuries: A multicenter retrospective study. Ulus Travma Acil Cerrahi Derg 21:291–296

    PubMed  Google Scholar 

  6. Allareddy V, Nalliah R, Lee MK, Rampa S, Allareddy V (2014) Impact of facial fractures and intracranial injuries on hospitalization outcomes following firearm injuries. JAMA Otolaryngol Head Neck Surg 140:303–311

    Article  Google Scholar 

  7. Davis JS, Castilla DM, Schulman CI, Perez EA, Neville HL, Sola JE (2013) Twenty years of pediatric gunshot wounds: an urban trauma center’s experience. J Surg Res 184:556–560

  8. Schecter SC, Betts J, Schecter WP, Victorino GP (2012) Pediatric penetrating trauma: the epidemic continues. J Trauma Acute Care Surg 73:721–725

    Article  Google Scholar 

  9. Myers SI, Reed MK, Black CT, Burkhalter KJ, Lowry PA (1989) Noniatrogenic pediatric vascular trauma. J Vasc Surg 10:258–265

    Article  CAS  Google Scholar 

  10. Dua A, Via KC, Kreishman P, Kragh JF Jr, Spinella PC, Patel B, Gillespie DL, Mahoney P, Fox CJ (2013) Early management of pediatric vascular injuries through humanitarian surgical care during U.S. military operations. J Vasc Surg 58:695–700

    Article  Google Scholar 

  11. Bell RS, Vo AH, Roberts R, Wanebo J, Armonda RA (2010) Wartime traumatic aneurysms: acute presentation, diagnosis, and multimodal treatment of 64 craniocervical arterial injuries. Neurosurgery 66:66–79 (discussion 79)

    Article  Google Scholar 

  12. Jakobsson KE, Carlsson C, Elfverson J, von Essen C (1984) Traumatic aneurysms of cerebral arteries. A study of five cases. Acta Neurochir (Wien) 71:91–98

    Article  CAS  Google Scholar 

  13. Aarabi B (1988) Traumatic aneurysms of brain due to high velocity missile head wounds. Neurosurgery 22:1056–1063

    Article  CAS  Google Scholar 

  14. Amirjamshidi A, Rahmat H, Abbassioun K (1996) Traumatic aneurysms and arteriovenous fistulas of intracranial vessels associated with penetrating head injuries occurring during war: principles and pitfalls in diagnosis and management. A survey of 31 cases and review of the literature. J Neurosurg 84:769–780

    Article  CAS  Google Scholar 

  15. Aarabi B (1995) Management of traumatic aneurysms caused by high-velocity missile head wounds. Neurosurg Clin N Am 6:775–797

    Article  CAS  Google Scholar 

  16. Bodanapally UK, Saksobhavivat N, Shanmuganathan K, Aarabi B, Roy AK (2015) Arterial injuries after penetrating brain injury in civilians: risk factors on admission head computed tomography. J Neurosurg 122:219–226

    Article  Google Scholar 

  17. Haddad FS, Haddad GF, Taha J (1991) Traumatic intracranial aneurysms caused by missiles: their presentation and management. Neurosurgery 28:1–7

    Article  CAS  Google Scholar 

  18. Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S (2011) Management of penetrating brain injury. J Emerg Trauma Shock 4:395–402

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the Neuroscience Publications staff at Barrow Neurological Institute for help with manuscript preparation.

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Correspondence to Ruth E. Bristol.

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The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this manuscript.

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Catapano, J.S., Hutchens, D.M., Cadigan, M.S. et al. Pediatric intracranial arterial injuries by penetrating gunshot wounds: an institutional experience. Childs Nerv Syst 37, 1279–1283 (2021). https://doi.org/10.1007/s00381-020-04974-z

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  • DOI: https://doi.org/10.1007/s00381-020-04974-z

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