Cranial Gunshot Wounds
A cranial gunshot wound is a penetrating wound through the skull caused by a firearm. As a bullet passes through the brain, the bullet creates a hole 3-4 times larger than the original bullet’s diameter. The majority of the damage in the brain is caused by the path of the bullet and the pressure wave it causes. Gunshot wounds are the most lethal cause of head injury worldwide.
Treatment Options
Gunshot wounds are emergency conditions that need to be managed promptly. Although the chances of patient survival are very low, the following line of treatment is generally performed:
- Aggressive resuscitation
- Maintaining blood pressure and oxygen level
- Surgery may be performed depending on patient’s consciousness and degree of brainstem neurological function
- Craniotomy is performed in identified cases of hematoma
Patients with minimal evidence of brainstem function and no evidence of an intracranial hematoma are not aggressively treated due to the certainty of a fatal outcome.
- Penetrating wound: A wound in which the bullet enters the skull, but does not exit
- Perforating wound: A wound in which the bullet enters and exits the skull
Cranial gunshot wounds are treated aggressively upon arrival at the emergency room. 90% of the victims of a cranial gunshot wound will die before arrival to the hospital. In victims that survive the initial stage, up to 50% may face death in the emergency room.
After stabilising the patient’s blood pressure and their oxygen levels, a computerised tomography (CT) scan is taken to get vision of the damage. Damage can be caused from the bullet entry, its pathway, bullet fragmentation, and its exit. The caliber of the bullet, the weapon from which it was fired, as well as the distance between the gun and the victim at the time of firing all play a vital role in the damage caused in the patient.
In cases where the patient has survived the initial gunshot wound, the outcome depends on the extent of injury and damage caused by it to the brain. Patient is admitted in the critical care unit for several weeks after the trauma to receive proper treatment and to also facilitate early recovery. Most of the cases require rehabilitation to regain lost function or to adapt to permanent injuries. Complete recovery could take several months or even several years.
