Lauren Turco1, David L Cornell2, Bradley Phillips3. 1. Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA. Electronic address: LTurco@kumc.edu. 2. Department of Surgery, Creighton University Medical Center, Omaha, Nebraska, USA. 3. CHS International, Cape Canaveral, Florida, USA.
Abstract
BACKGROUND: Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. METHODS: PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. RESULTS: Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. CONCLUSIONS: Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.
BACKGROUND: Head injuries that cross midline structures of the brain are bihemispheric. Other terms have been used to describe such injuries, but bihemispheric is the most accurate and should be standard nomenclature. Bihemispheric head injuries are associated with greater mortality and morbidity than other penetrating traumatic brain injuries (TBIs). Currently, there is a tendency to manage severe gunshot wounds (GSWs) to the head nonoperatively, despite reports of improved outcome in military patients treated aggressively. Thus, controversy exists in the management of civilian TBI. METHODS: PubMed was searched for query terms, and PRISMA guidelines were used. Studies were selected by relevance and inclusion of data regarding etiology, diagnosis, and management of bihemispheric TBI. Case reports, studies not in English, and records lacking information on mechanism or bihemispheric injuries were excluded. RESULTS: Thirteen studies were included and most contained level IV evidence. The mean mortality rate of all head GSWs was 62% in adults and 32% in children. Bihemispheric GSWs had greater mortality rates of 82% in adults and 60% in children. There was a larger proportion of self-inflicted injury in studies with greater rates of bihemispheric injuries. CONCLUSIONS: Bihemispheric injuries have greater mortality rates than other penetrating TBI. Violation of midline brain structures such as the diencephalon and mesencephalon, increased rate of self-inflicted wounds, and lack of a standard management algorithm may increase the lethality of these injuries. Although bihemispheric injuries historically have been considered nonsalvageable, an aggressive surgical approach has been shown to improve outcomes, particularly in the military population.
Authors: Franz Marhold; Florian Scheichel; Barbara Ladisich; Philip Pruckner; Elisabeth Strasser; Melanie Themesl; Karl Ungersboeck; Branko Popadic Journal: Front Surg Date: 2022-06-28
Authors: Leigh Anna Robinson; Lauren M Turco; Bryce Robinson; Joshua G Corsa; Michael Mount; Amy V Hamrick; John Berne; Dalier R Mederos; Allison G McNickle; Paul J Chestovich; Jason Weinberger; Areg Grigorian; Jeffry Nahmias; Jane K Lee; Kevin L Chow; Erik J Olson; Jose L Pascual; Rachele Solomon; Danielle A Pigneri; Husayn A Ladhani; Joanne Fraifogl; Jeffrey Claridge; Terry Curry; Todd W Costantini; Manasnun Kongwibulwut; Haytham Kaafarani; Janika San Roman; Craig Schreiber; Anna Goldenberg-Sandau; Parker Hu; Patrick Bosarge; Rindi Uhlich; Nicole Lunardi; Farooq Usmani; Joseph Victor Sakran; Jessica M Babcock; Juan Carlos Quispe; Lawrence Lottenberg; Donna Cabral; Grace Chang; Jhoanna Gulmatico; Jonathan J Parks; Rishi Rattan; Jennifer Massetti; Onaona Gurney; Brandon Bruns; Alison A Smith; Chrissy Guidry; Matthew E Kutcher; Melissa S Logan; Michelle Y Kincaid; Chance Spalding; Matthew Noorbaksh; Frances H Philp; Benjamin Cragun; Robert D Winfield Journal: Trauma Surg Acute Care Open Date: 2019-11-17