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Child's Nervous System

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01-04-2021 | Gunshot Wound | Original Article

Surgical management of pediatric patients with peripheral nerve and plexus lesions caused by stray bullets

Authors: Fernando Guedes, Gabriel Elias Sanches, Nathalia Novaes, Amanda Guimarães Ferreira, Francisco Torrão

Published in: Child's Nervous System | Issue 4/2021

Abstract

Purpose

Children and adolescents are frequent victims of gunshot wounds (GSW), either by direct intent or accidentaly. Lesions caused by stray bullets represent a specific type of accidental GSW and are usually associated with urban violence or aerial firing. We thereby present a series of surgically treated pediatric patients with peripheral nerve and brachial plexus lesions caused by stray bullets, referring to their clinical presentation, surgical procedures, and outcomes.

Methods

Retrospective study of a series of seven pediatric patients treated from 2012 to 2019 for nerve and/or plexus lesions caused by stray bullets at the Peripheral Nerve Unit of the Division of Neurosurgery of Gaffrée e Guinle University Hospital (HUGG). We used the Visual Analog Scale (VAS) to evaluate pain distress and the British Medical Research Council grading system (BMRC) to assess muscle strength.

Results

Patients’ ages ranged from 6 to 17 years old (median of 16), and two were female. All presented preoperatively with intense pain, with a median VAS of 9 (range 7 to 10), and six also had neurological deficits. External neurolysis was conducted in all cases, whereas reconstruction with grafts was needed in four patients. All experienced improvement of pain, and those with motor deficits also experienced some level of recovery.

Conclusion

Pediatric patients who endure lesions by stray bullets appear to present with debilitating pain, and often with motor deficits. Multidisciplinary management comprising of surgical treatment and physical and occupational therapy may ameliorate symptoms and improve quality of life, as young patients usually fare better after surgery.

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Title: Surgical management of pediatric patients with peripheral nerve and plexus lesions caused by stray bullets
Authors: Fernando Guedes
Gabriel Elias Sanches
Nathalia Novaes
Amanda Guimarães Ferreira
Francisco Torrão
Publication date: 01-04-2021
Publisher: Springer Berlin Heidelberg
Keyword: Gunshot Wound
Published in: Child's Nervous System / Issue 4/2021
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-020-04951-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Surgical management of pediatric patients with peripheral nerve and plexus lesions caused by stray bullets

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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