平民颅脑枪伤的手术与非手术疗法

IF 0.4 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-03-31 DOI:10.1016/j.inat.2025.102022

Wesley Shoap , George Austin Crabill , Roboan Guillen , Kaleb Derouen , Jack Leoni , Zhide Fang , Berje Shammassian

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引用次数: 0

摘要

平民的颅脑枪伤构成了创伤性脑损伤（TBI）的一个毁灭性子集。本研究的目的是根据干预时间和类型确定颅脑枪击患者的死亡率、重症监护病房住院时间（ICU LOS）和格拉斯哥结局扩展量表（GOS-E）之间的关系。方法查询2016年1月1日至2023年6月1日期间接受神经外科干预的15岁及以上GSWH患者的创伤数据库。回顾手术记录，将患者分为三组；颅内压监测仪仅与药物治疗（ICP），一次减压颅骨切除术（pDC），或二次减压颅骨切除术（sDC）。计算脑穿透伤存活评分（SPIN）。结果包括死亡率、ICU LOS和GOS-E。结果总共有72例患者接受了颅骨减压手术或颅内压监测。平均SPIN评分相似：ICP， pDC和sDC （30.5, 32.67, 31.55 (p = 0.4252)）。两组比较，ICP组的死亡几率高于pDC组（OR = 3.71, 95% CI = 1.06, 14.35）。在住院轨迹方面，ICU LOS（平均天数）各组间存在差异：ICP、pDC、sDC(16.7、17.4、23.4；p = 0.0002)。结论与单纯内科治疗的颅内压监测相比，首次颅内压减压术的死亡率降低，且与二次颅内压减压术相比，其ICU LOS较短。在适当选择的患者中，应考虑早期和积极的减压。

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Surgical versus nonsurgical management of civilian craniocerebral gunshot injuries

Introduction

Craniocerebral gunshot wounds in the civilian population constitute a devastating subset of traumatic brain injuries (TBI). The aim of this study was to determine the association of mortality, intensive care unit length of stay (ICU LOS), and the Glasgow Outcome Scale Extended (GOS-E) among craniocerebral gunshot patients based on timing and type of intervention.

Methods

The trauma database was queried for GSWH patients ages 15 and older who received neurosurgical intervention from January 1st 2016 to June 1st 2023. Operative notes were reviewed and patients were then divided into three groups; intracranial pressure monitor only with medical treatment (ICP), primary decompressive craniectomy (pDC), or secondary decompressive craniectomy (sDC). The Surviving Penetrating Injury to the Brain (SPIN) score was calculated. Outcomes included mortality, ICU LOS, and GOS-E.

Results

Overall, 72 patients were identified who underwent either decompressive craniectomies or ICP monitoring. Mean SPIN scores were similar: ICP, pDC and sDC (30.5, 32.67, 31.55 (p = 0.4252)). When comparing two groups, the odds of death was higher in the ICP group compared to the pDC group (OR = 3.71, 95 % CI = 1.06, 14.35). With regard to hospital trajectory, ICU LOS (mean days) was different among the groups: ICP, pDC, sDC (16.7, 17.4, 23.4; p = 0.0002).

Conclusion

Mortality was reduced with primary decompressive craniectomy when compared to ICP monitoring with medical management alone and is associated with shorter ICU LOS compared to secondary decompressive craniectomy. In the appropriately selected patient, early and aggressive decompression should be considered.

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