Cranial Procedures For Penetrating Head Injury

Penetrating brain injury is one of the most challenging indications for cranial procedures performed by neurosurgeons.

1. Exploration without teleconsultation from a neurosurgeon is NOT
2. There is often deep and uncontrollable bleeding that may not be evident on the cortical surface.
3. Surgical exploration below the surface of the brain is NOT
4. Surgical intervention should be limited to removing bone, opening the dura, controlling bleeding, and closing the skin rapidly.

If cranial contents are herniated from either the entry or exit wound, allow this to continue. Do not close the wound. Recommend coverage with a loose, clean dressing (Kerlix soaked in saline) and initiate and maintain IV antibiotic coverage with central nervous system penetration.

Adequately resuscitate as necessary, and transport at the soonest opportunity.

If evacuation to a higher role of care is not possible, recognize that intervention in this case may be futile.