EMERGENCY AND MANAGEMENT OF CRANIOCEREBRAL GUNSHOTS-REVIEW ARTICLES

Hatim Faihan Alotaibi*, Ibrahim Mohammed Alanazi, Adel Mohammad Aldukhain, Hamoud Ghayyadh Alanizi and Saif helal Almutairi

ABSTRACT

Background: Craniocerebral gunshot wounds (CGIs) have evolved from being primarily a military concern to a prevalent issue in civilian settings, particularly in developing nations. These injuries are among the most fatal firearm injuries, with survival rates between 7% and 15%. A substantial percentage of patients die either at the scene or within the first few hours post-injury. This review aims to address the contemporary understanding of ballistic impacts, pathophysiology, diagnostic approaches, and management strategies for CGIs. Aim: To explore the latest advancements in understanding and managing craniocerebral gunshot wounds, focusing on ballistic considerations, injury mechanisms, diagnostic imaging, and treatment protocols. Also, to evaluate the main role of emergency team, nurses, health informatics specialists, and other healthcare providers. Methods: This review synthesizes existing literature on ballistics, pathophysiology, neuroimaging, and treatment methodologies related to CGIs. It categorizes injuries based on projectile characteristics and outlines the role of various imaging techniques and surgical interventions. Results: High-velocity projectiles cause extensive damage through mechanisms such as temporary cavitation and secondary fragmentation. Imaging modalities like CT and MRI are crucial for diagnosis and treatment planning, although MRI is less preferred due to risks with ferromagnetic materials. Surgical management ranges from conservative approaches to aggressive debridement, depending on the injury severity and patient condition. Conclusion: Effective management of CGIs requires an integrated approach, combining prompt resuscitation, precise neuroimaging, and tailored surgical interventions. Advancements in ballistic understanding and imaging have improved outcomes, but challenges remain in balancing aggressive treatment with potential complications.

Keywords: Craniocerebral gunshot wounds, Ballistics, Pathophysiology, Neuroimaging, Surgical management.