Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb:146:e1031-e1044.
doi: 10.1016/j.wneu.2020.11.078. Epub 2020 Nov 21.

Traumatic Cerebrovascular Injuries Associated with Gunshot Wounds to the Head: A Single-Institution Ten-Year Experience

Fakhry M Dawoud  1 , Michael J Feldman  2 , Aaron M Yengo-Kahn  3 , Steven G Roth  3 , Daniel I Wolfson  4 , Ranbir Ahluwalia  5 , Patrick D Kelly  3 , Rohan V Chitale  3
Affiliations

Traumatic Cerebrovascular Injuries Associated with Gunshot Wounds to the Head: A Single-Institution Ten-Year Experience

Fakhry M Dawoud et al. World Neurosurg. 2021 Feb.

Abstract

Background: Cerebrovascular injury (CVI) is a potentially devastating complication of gunshot wounds to the head (GSWH), with yet unclear incidence and prognostic implications. Few studies have also attempted to define CVI risk factors and their role in patient outcomes. We aimed to describe 10 years of CVI from GSWH and characterize these injury patterns.

Methods: Single-institution data from 2009 to 2019 were queried to identify patients presenting with dural-penetrating GSWH. Patient records were reviewed for GSWH characteristics, CVI patterns, management, and follow-up.

Results: Overall, 63 of 297 patients with GSWH underwent computed tomography angiography (CTA) with 44.4% showing CVI. The middle cerebral artery (22.2%), dural venous sinuses (15.9%), and internal carotid artery (14.3%) were most frequently injured. Arterial occlusion was the most prominent injury type (22.2%) followed by sinus thrombosis (15.9%). One fifth of patients underwent delayed repeat CTA, with 20.1% showing new/previously unrecognized CVI. Bihemispheric bullet tracts were associated with CVI occurrence (P = 0.001) and mortality (P = 0.034). Dissection injuries (P = 0.013), injuries to the vertebrobasilar system (P = 0.036), or the presence of ≥2 concurrent CVIs (P = 0.024) were associated with increased risk of mortality. Of patients with CVI on initial CTA, 30% died within the first 24 hours.

Conclusions: CVI was found in 44.4% of patients who underwent CTA. Dissection and vertebrobasilar injuries are associated with the highest mortality. CTA should be considered in any potentially survivable GSWH. Longitudinal study with consistent CTA use is necessary to determine the true prevalence of CVI and optimize the use of imaging modalities.

Keywords: Cerebrovascular injury; Computed tomography angiography; Gunshot wounds to the head; Penetrating head injury.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow diagram showing the process of inclusion and exclusion of patients. CTA, computed tomography angiography; CVI, cerebrovascular injury,
Figure 2.
Figure 2.
Kaplan-Meier curve of overall survival for patients with and without vascular injury on screening computed tomography angiography (CTA).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Alvis-Miranda HR, Rubiano AM, Agrawal A, et al. Craniocerebral gunshot injuries; a review of the current literature. Bull Emerg Trauma. 2016;4:65. - PMC - PubMed
    1. Frösen J, Frisk O, Raj R, Hernesniemi J, Tukiainen E, Barner-Rasmussen I. Outcome and rational management of civilian gunshot injuries to the brain–retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012. Acta Neurochir (Wien). 2019;161:1285–1295. - PMC - PubMed
    1. Vakil MT, Singh AK. A review of penetrating brain trauma: epidemiology, pathophysiology, imaging assessment, complications, and treatment. Emerg Radiol. 2017;24:301–309. - PubMed
    1. Bizhan A, Mossop C, Aarabi JA. Surgical management of civilian gunshot wounds to the head. HandbClinNeurol. 2015;127:181–193. - PubMed
    1. Van Wyck DW, Grant GA. Penetrating traumatic brain injury: a review of current evaluation and management concepts. J Neurol Neurophysiol. 2015;6.

MeSH terms

LinkOut - more resources