The African Journal of Neurological Sciences
Vol 14 No.1, 1995
Migrating retained intracranial missiles
Buwembo J. D, Villiers J.G.
Code Number: NS95001
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SUMMARY
Five cases of retained, migrating intracranial bullets are
presented. The bullet migrated transventricularly in four
patients and subdurally in one. In five cases the bullets were
safely removed: via craniotomy for the four patients with an
intraventricular location and through a borehole for the
patient with a subcortical location. One patient presented a
year after injury with severe headache, due to the bullet
having become a third ventricular foreign body. The
difficulties experienced in localising the missile using
computerised tomography (CT) due to metallic artefact and the
usefulness of air encephalography in one of the cases, are
demonstrated. Intra-operative localisation using an image
intensifier prior to siting the craniotomy, is essential.
RESUME
Cinq observations de projectiles a migration intracranienne
sont rapportees. Les bailes ont migre a travers les
ventricules chez quatre patients et en region sous-durale chez
le cinquieme. Les 4 balles ayant une localization
intraventriculaire ont ete retirees par craniotomie ete
travers un trou de trepan pour la balle a localization durale.
Un des patients se presenta un an apres le traumatisme avec
des cephalees intenses, en raison de la localization du
projectile dans le troisieme ventricule. Les difficutes de
localization du projectile par tomodensitometrie a cause des
artefacts metalliques, et l'utilite de l'encephalographie
gazeuse dans un cas, sont soulignees. La localization precise
preoperatoire par amplificateur de brillance est essentille
avant de realiser la craniotomy.
Key Words: Gunshot wound, craniocerebral wound,
intracranial body, retained intracranial missile,
migrating missile.
Copyright 1995 Pan African Association of Neurologcal Sciences
