Conservative Management of Retained Intracranial Pellets in Civilian Gunshot Injuries

Background: A cranio-cerebral firearm injury is an emergency with high morbidity and mortality. A standout amongst the most captivating and disputable part in their management in salvageable patients is the decision to remove the pellet. A pellet is foreign to brain and in principle should be removed. Because of their tiny sizes rendering removal difficult, the risk of their removal should be weighed against benefits of conservation. Objective: Our study meticulously outlines the short-term outcome of conservative management of retained Intracranial Pellets in Civilian Gunshot Injuries. Patients and Methods: We prospectively followed up a cohort of twenty patients with retained pellets from January 2011 to 2014. Intravenous an tibiotics and antiepileptic were given and Glasgow Coma Scale (GCS) and vital data recorded. After discharge, they were followed up for at least seven months, Glasgow Outcome Score (GOS) was used to assess functional outcome. Results: The mean age of our cohort of twenty patients was 27±14.9 years, the median GCS on admission was 14, median length of hospital stay was 7 days and follow up duration was 10 months. GOS on discharge was good in fitieen cases (75%) while two deaths were registered. None of them developed infection nor seizures during the follow up period. Conclusion: Our short-term outcome supports conservation as the first line of treatment for retained intracranial pellets. Long-term follow-up for the outcome of infection and seizures is recommended.