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Craniospinal Missile Injuries
Harjinder Singh Bhatoe
1:
Introduction
2:
Historical Perspective
INTRODUCTION: EARLY MISSILES
EVOLUTION OF MANAGEMENT
Casualty Evacuation
MISSILE INJURIES OF THE SPINE
INDIAN EXPERIENCE
CONCLUSION
3:
Ballistics Physics
THE MISSILES
ENERGY TRANSFER
Illustrative Case
PHYSICAL EFFECTS OF MISSILE WOUNDING
SECONDARY MISSILES
CONCLUSION
REFERENCES
4:
Pathophysiology and Mechanism of Brain Injury
IMMEDIATE EFFECT ON INTRACRANIAL PRESSURE
EFFECTS ON CEREBRAL BLOOD FLOW
HAEMODYNAMIC ALTERATIONS AFTER CMI OBSERVATIONS IN HUMANS
EFFECT OF CMI ON BREATHING
MECHANISM OF BRAIN INJURY
COAGULATION ABNORMALITIES AFTER CMI
CONCLUSION
5:
Clinical Evaluation: Pretreatment Algorithm
TRIAGE AND ACTION AT THE SITE OF INJURY DEALING WITH MASS CASUALTIES
COMMUNICATION AND EVACUATION
ACTION AT PERIPHERAL MEDICAL SET UP
Preliminary Medical Management
EXAMINATION OF A PATIENT WITH CMI
Examination of Head and Neck
Baseline Neurological Evaluation
Illustrative Case
CONCLUSION
6:
Imaging
SKULL RADIOGRAPH
COMPUTED TOMOGRAPHY
The Missile Track
Intracranial Haematomas
Neurological Deterioration and Serial CT
MAGNETIC RESONANCE IMAGING
CEREBRAL ANGIOGRAPHY
IMAGING IN CMI AND PROGNOSTICATION
CONCLUSION
7:
Surgical Management
INTRODUCTION WHOM TO OPERATE?
PRINCIPLES OF SURGERY
WOUND DEBRIDEMENT AND OPERATIVE MANAGEMENT
Exposure
Wound Management and Haemostasis
Closure
CONTROVERSIES
Removal of Intracranial Fragments
Extent of Debridement
Craniectomy or Craniotomy?
CERTAIN SPECIAL CONSIDERATIONS
Migrating Missiles
Facio-orbito-cranial Injuries
Vascular Injuries
SURGERY FOR SEQUELAE
CSF Rhinorrhoea
Brain Abscess
Hydrocephalus
PROGNOSTIC FACTORS
Glasgow Coma Scale
Subarachnoid Haemorrhage
Vasospasm
Pupillary Reaction
Coagulopathy
Extent of Cerebral Parenchymal Involvement
Hypotension
CONCLUSION
8:
Postoperative Management and Intensive Care
INTRODUCTION
OXYGENATION And IMPROVING SUBSTRATE DELIVERY
Oxygenation
Substrate Delivery
Treatment of Tissue Acidosis
MANAGEMENT OF RAISED ICP
Diuresis
Ventilatory Support and Hyperventilation
ANTIBIOTICS AND PREVENTION OF INFECTION
Choice of Antibiotics
Penicillin
Chloramphenicol
Third Generation Cephalosporins
Netilmicin
Vancomycin
Metronidazole
ANTICONVULSANTS
MONITORING, NUTRITIONAL SUPPORT AND NURSING MANAGEMENT
Clinical Parameters
Bedside Monitoring
Nutritional Support
Nursing Care
9:
Post-traumatic Epilepsy
EARLY SEIZURES
LATE EPILEPSY
PATHOGENESIS
MANAGEMENT
10:
Retained Intracranial Splinters
INTRODUCTION
REVIEW OF THE PROBLEM
SEQUELAE OF RETAINED INTRACRANIAL SPLINTERS
Infective Complications
Illustrative Case
Epilepsy
Migration
MANAGEMENT STRATEGY
11:
Missile Injuries of the Spine
INTRODUCTION
LOCATION OF WOUND
THE MISSILES AND MECHANISM OF INJURY
Illustrative Cases
APPROACH TO A PATIENT WITH MIS
IMAGING
Plain Radiography
Myelography
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
CONTROVERSIES AND EVOLUTION OF TREATMENT PHILOSOPHY
The Intraspinal Fragment
Cauda Equina Injury
Spine Stabilisation
CURRENT MANAGEMENT
Wound Debridement
Operative Management for MIS
Post-operative Management
SEQUELAE
Pain
Delayed Neurological Deterioration
CONCLUSION
INDEX
TOC
Index
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