Management of Cranial Air Gun Pellet Injuries

Background: Pellets commonly enter the skull through orbit, temporal and occipital bones. Cranial air gun pellet injury may be penetrating or perforating .These pellets may cause: intracranial hemorrhage, traumatic aneurysm, carotid - cavernous fistula. Fatalities from these injuries depend on the damaged part of the brain and the extent of this damage. Objectives: the aim of this study is to evaluate the clinical sequelae and management of cranial air gun pellet injuries. Patients and Methods: This is a retrospective study of fifty eight patients admitted to the Emergency hospital, Mansoura University in the last 4years with cranial air gun pellet injuries. All patients were evaluated clinically using GCS on admission. X-ray skull bone was done for fifty two patients. CT scan brain was done for all patients. Thirty one patients were operated upon. Clinical and radiological follow up for all patients was done for a period ranging from 6 to 24 months (mean 14 months). Results: This study included fifty eight patients with cranial air gun pellet injuries: fifty males and eight females. Age ranged from 2 to 60 years. According to GCS score: 65.5% had mild, 24.15% moderate and 10.35% severe head trauma. 74.1% of patients had single pellet and 25.9% had multitiple pellets. The commonest site of entry was temporal (44.7%). Two patients (3.4 %) had subgalial pellets. Thirty one patients were operated upon. Mortality occurred in six patients. Morbidity included: superficial wound infection (eight patients), CSF leakage (six patients), meningitis (two patients), and brain abscess (three patients). Conclusion: Patients with cranial air gun pellet injuries should receive prophylactic antibiotics and anti-epileptics. Patients with mild or moderate head trauma should be operated for removal of any in driven bony or metal fragments if accessible, especially when associated with intracranial hematoma. Conservative management for patients with severe head trauma is recommended particularly with multiple intracranial affection.