Andrea Loggini1, Valentina I Vasenina2, Ali Mansour1, Paramita Das2, Peleg M Horowitz2, Fernando D Goldenberg3, Christopher Kramer3, Christos Lazaridis4. 1. Department of Neurology, Neurocritical care unit, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, 60637-1470 Chicago, IL, USA. 2. Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 3026, 60637-1470 Chicago, IL, USA. 3. Department of Neurology, Neurocritical care unit, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, 60637-1470 Chicago, IL, USA; Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 3026, 60637-1470 Chicago, IL, USA. 4. Department of Neurology, Neurocritical care unit, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, 60637-1470 Chicago, IL, USA; Section of Neurosurgery, Department of Surgery, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 3026, 60637-1470 Chicago, IL, USA. Electronic address: Lazaridis@uchicago.edu.
Abstract
PURPOSE: There has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI. METHODS: We explored: (1) cervical spine immobilization, (2) seizure incidence and prophylaxis, (3) infection incidence and antibiotic prophylaxis, (4) coagulopathy (5) vascular complications, and (6) surgical management. We searched PubMed, EMBASE, and Cochrane (1985-2019). The PRISMA guidelines were followed. The Newcastle-Ottawa Scale was employed for qualitative assessment; risk of bias was evaluated based upon the RTI item bank. The full protocol was registered to PROSPERO (CRD42019118877). RESULTS: The literature is scant, and of overall low quality and high risk of bias. Incidence of c-spine injury with no direct trauma is low; incidence of seizures does not appear to be different from non-penetrating mechanisms; there is no robust data for prophylactic antibiotics; coagulopathy is prevalent and has been independently associated with outcome; there is a high incidence of vascular injuries with traumatic intracranial aneurysms the most common sequelae; neurosurgical decision-making appears largely influenced by operator's assessment of salvageability. Surgery has been associated with decreased mortality. CONCLUSIONS: Limited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.
PURPOSE: There has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI. METHODS: We explored: (1) cervical spine immobilization, (2) seizure incidence and prophylaxis, (3) infection incidence and antibiotic prophylaxis, (4) coagulopathy (5) vascular complications, and (6) surgical management. We searched PubMed, EMBASE, and Cochrane (1985-2019). The PRISMA guidelines were followed. The Newcastle-Ottawa Scale was employed for qualitative assessment; risk of bias was evaluated based upon the RTI item bank. The full protocol was registered to PROSPERO (CRD42019118877). RESULTS: The literature is scant, and of overall low quality and high risk of bias. Incidence of c-spine injury with no direct trauma is low; incidence of seizures does not appear to be different from non-penetrating mechanisms; there is no robust data for prophylactic antibiotics; coagulopathy is prevalent and has been independently associated with outcome; there is a high incidence of vascular injuries with traumatic intracranial aneurysms the most common sequelae; neurosurgical decision-making appears largely influenced by operator's assessment of salvageability. Surgery has been associated with decreased mortality. CONCLUSIONS: Limited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.
Authors: Ali Mansour; Andrea Loggini; Fernando D Goldenberg; Christopher Kramer; Andrew M Naidech; Faten El Ammar; Valentina Vasenina; Brandyn Castro; Paramita Das; Peleg M Horowitz; Theodore Karrison; Tanya Zakrison; David Hampton; Selwyn O Rogers; Christos Lazaridis Journal: J Neurotrauma Date: 2021-01-20 Impact factor: 4.869
Authors: Andrea Loggini; Tareq Kass-Hout; Issam A Awad; Faten El Ammar; Christopher L Kramer; Fernando D Goldenberg; Christos Lazaridis; Ali Mansour Journal: Front Neurol Date: 2022-02-11 Impact factor: 4.003
Authors: Fakhry M Dawoud; Michael J Feldman; Aaron M Yengo-Kahn; Steven G Roth; Daniel I Wolfson; Ranbir Ahluwalia; Patrick D Kelly; Rohan V Chitale Journal: World Neurosurg Date: 2020-11-21 Impact factor: 2.104
Authors: Ali Mansour; Andrea Loggini; Faten El Ammar; Daniel Ginat; Issam A Awad; Christos Lazaridis; Christopher Kramer; Valentina Vasenina; Sean P Polster; Anna Huang; Henry Olivera Perez; Paramita Das; Peleg M Horowitz; Tanya Zakrison; David Hampton; Selwyn O Rogers; Fernando D Goldenberg Journal: Neurocrit Care Date: 2020-10-06 Impact factor: 3.532