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Penetrierende Schädel-Hirn-Verletzungen durch Schusswaffen

Diagnostik, Behandlungsmanagement und Prognose

Penetrating gunshot injuries to the head and brain

Diagnosis, management and prognosis

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Zusammenfassung

Kopfschussverletzungen sind außerhalb von Kriegszeiten in Deutschland und Westeuropa selten. Aufgrund eher geringer Fallzahlen hierzulande sind die diagnostischen und therapeutischen Behandlungsstandards uneinheitlich und kontrovers. Ursache dieser Verletzung sind nicht selten Selbsttötungsabsichten oder Unfälle. Diagnostisch stehen dem behandelnden Mediziner in erster Linie die Computertomographie mit Kontrastmittel und – in Ausnahmefällen – auch die Magnetresonanztomographie zur Verfügung. Was das operative Vorgehen angeht, wird das Débridement des Schusskanals mit evtl. Entfernung des Projektils kontrovers diskutiert, die Indikation zur Anlage eine Ventrikeldränage sollte hingegen großzügig gestellt werden. Werden diese Verletzungen, die eine außerordentlich hohe Mortalität haben, überlebt, ist die Prognose der von geschlossenen Schädel-Hirn-Traumen vergleichbar.

Abstract

Gunshot injuries to the head and brain are rare in Germany and the rest of western Europe. With the relatively low number of these injuries here, there are no standard methods of diagnosis and management, and there is some controversy over both. Quite a high proportion of such injuries result from suicide attempts and accidents. The main diagnostic procedure available is computed tomography of the head with contrast medium; in certain cases MRI is indicated. The operative management depends on the extent and prognosis of the injury; a ventricular drain is probably indicated in most cases. Debridement of the bullet’s path and removal of the projectile are more controversial. Mortality is extremely high after such injuries; if the victim does survive the prognosis is comparable to that following closed cranial injuries.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 , Essen, Deutschland

    C.A. Kühne, R.P. Zettl, G. Taeger, S. Ruchholtz & D. Nast-Kolb

  2. Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Essen, Essen, Deutschland

    B. Baume & D. Stolke

  3. Abteilung für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen, Deutschland

    F.M. Vogt

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  1. C.A. Kühne
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Correspondence to C.A. Kühne.

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Kühne, C., Zettl, R., Baume, B. et al. Penetrierende Schädel-Hirn-Verletzungen durch Schusswaffen. Unfallchirurg 110, 341–350 (2007). https://doi.org/10.1007/s00113-007-1244-4

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