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Journal of Neurosurgical Sciences 2000 June;44(2)107-12

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Cranio-orbital missile wound and bullet migration. Case report

Rinaldi A. 1, Gazzeri R. 1, Conti L. 2, Schiavone M. 2, Cava M. 4, Coen Tirelli G. 3

1 Department of Neurosciences - Neurosurgery, S. Filippo Neri Hospital, Rome, Italy; 2 Department of Neurology, S. Filippo Neri Hospital, Rome, Italy; 3 Department of Otolaryngology, S. Filippo Neri Hospital, Rome, Italy; 4 Department of Clinical Laboratory, S. Filippo Neri Hospital, Rome, Italy


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An unusu­al ­case of cra­ni­o­cer­e­bral mis­sile inju­ry, ­with orbi­tal ­roof per­fo­ra­tion ­and spon­ta­ne­ous bul­let migra­tion ­into ­the max­il­lary ­sinus, is report­ed. Emer­gen­cy treat­ment con­sist­ed in ­wide cra­niec­to­my ­around ­the bul­let ­entry ­point, ­blood ­and for­eign bod­ies debrid­ment. Sub­se­quent pro­ce­dures ­were nec­es­sary ­for ­abscess evac­u­a­tion, trans­max­il­lary bul­let remov­al ­and lat­er cra­ni­al ­vault recon­struc­tion. Chal­leng­ing ­aspects ­were ­the treat­ment of ­the infec­tious com­pli­ca­tions, fol­low­ing cere­bro­spi­nal ­fluid fis­tu­la ­through ­the ­wound, ­and ­the ­onset of ­post-trau­mat­ic epi­lep­sy, scarse­ly respon­sive to com­mon anti­epi­lep­tic ­drugs. ­The treat­ment of ­the ­abscess by com­bined system­ic ­and intra­cav­i­tary anti­bi­o­tic ther­a­py ­and of ­the chron­ic sei­zures by pro­gres­sive adjust­ment ­with ­new pro­to­cols of anti­epi­let­ic ­drugs ­under ­EEG ­and ­brain map­ping ­revealed suc­cess­ful.

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