Combination of dura turning-over and decompressive craniectomy: a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury

Qi-Yong Mei; Yao Li; Chao He; Hong-Wei Shan; Yun-Kun Wang; Yan Dong; Ming-Kun Yu; Li-Jun Hou

doi:10.1186/s40779-017-0135-4

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Combination of dura turning-over and decompressive craniectomy: a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury

CASE REPORT | Updated：2026-03-12

- Combination of dura turning-over and decompressive craniectomy: a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury
- Military Medical Research Vol. 5, Issue 1, Pages: 85-89(2018)
- Affiliations：
  
  1.Department of Neurosurgery, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai Neurosurgical Institute, Shanghai 200003, China
  2.Department of Hepatic Surgery III, Eastern Hepatobiliary Surgical Hospital, Shanghai 200438, China
  3.Department of Emergency, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
- Author bio：
  
  *: shczyyns@163.com
- Funds：
- DOI：10.1186/s40779-017-0135-4
  CLC：
- Published：2018-03
- Accepted：
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Mei et al.: Combination of dura turning-over and decompressive craniectomy: a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury. Mil Med Res, 2017, 4: 26
DOI：

Mei et al.: Combination of dura turning-over and decompressive craniectomy: a new pattern of surgery for cerebral infarction caused by craniocerebral gunshot injury. Mil Med Res, 2017, 4: 26 DOI： 10.1186/s40779-017-0135-4.

摘要

Abstract

Background:

Craniocerebral gunshot injury refers to a wound caused by a bullet passing through or lodged in brain tissue

resulting in the loss of function of a certain area or other fatal damage to the human brain. Craniocerebral gunshot injury is usually life-threatening and is very common in modern warfare

accounting for the majority of battle casualties. Most of the patients suffer from acute cerebral infarction caused by vascular injury. Lack of early and solid battlefield emergency medical interference adds to the risk of death among the wounded.

Case presentation:

We present a 24-year-old man who was shot with a shotgun from a distance of 15m in an accidental injury. Forty-seven grape shots were found on his body surface by physical examination. A computed tomography (CT) scan demonstrated large areas of low-density shadows in his right parietal lobe and right temporal lobe with the midline shifting to the left side 2 days later. Afterwards

the patient was transferred to our emergency medical center at Changzheng Hospital in Shanghai. Cranial computed tomography angiography (CTA) showed a high-density shadow in the initial part of the right middle cerebral artery. The branches after the initial part were obliterated. Prompt medical attention and decompressive craniotomy (DC) surgery contributed to the final recovery from cerebral infarction of this patient.

Conclusion:

Bullets can penetrate or be lodged in the brain

causing intracranial hypertension. The bullets lodged in the brain can result in stenosis and embolism of a cerebral artery

causing acute cerebral infarction. Combining dura turning-over surgery with DC surgery can not only decrease intracranial pressure

which can increase the blood supply for hypertension-induced vessel stenosis

but also help vessels outside the dura mater grow into ischemic areas of the cerebral cortex. However

this new pattern of surgery needs further support from evidence-based medicine.

关键词

Keywords

references

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