PMC5561627_01
Picture and CT image of the patient. The patient with gunshot wounds showed recovery of the intracranial blood supply and physical ability gradually due to our contribution of surgery.a Multiple gunshot wounds in the skin of this patient; b CT scan revealing large parts of low-density shadows in the right frontal lobe, right parietal lobe and right temporal lobe before the surgery; c CT scan revealing the pellet lodged in the brain; d, e DSA showed the branches after the initial part of the right middle cerebral artery (MCA) were obliterated; f CT scan showed decreased low-density areas with the midline moving back 24 h after the surgery; g Posterior-anterior picture of the patient 2 weeks after the surgery showed a decreased difference between two sides of the face; h The patient left the hospital with myodynamia degree III of his left upper limb, degree V of the proximal part of his left lower limb and degree V of the distal part of his left lower limb
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PMC5561627_01_40779_2017_135_Fig1_HTML.jpg
Fig1
A 24-year-old man suffered from an accidental gunshot injury on December 15, 2015 (Fig. 1a). An emergency CT scan showed pellets in the saddle area of the brain (Fig. 1c), pericardium, stomach and intestines. Cranial CTA and digital subtraction angiography (DSA) was performed immediately and it showed a high-density shadow in the initial part of the right middle cerebral artery (Fig. 1d, e). Although the formation of compensatory circulation had taken place, the ischemic situation of the patient's brain tissue had not improved effectively according to the low-density areas in the CT scan examination (Fig. 1b). CT scan showed decreased low-density areas with the midline-line moving back 24h after the surgery (Fig. 1f).  Posterior-anterior picture of the patient 2 weeks after the surgery showed a decreased difference between two sides of the face (Fig. 1g). Eighteen days after the surgery, medical examination of the nervous system showed myodynamia degree IV of his left upper limb, degree V of the proximal part of his left lower limb and degree V of the distal part of his left lower limb (Fig. 1h).
Three steps of the surgery procedure.a We found the area in his dura mater that we decided to turn over, while we did not cut the initial part of the vessel; b We turned-over this part of dura mater at the end of the initial part of the vessel; c A relaxed suture was used to close the incision
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PMC5561627_01_40779_2017_135_Fig2_HTML.jpg
Fig2
We removed a part of the skull in the area of the frontal bone, temporal bone and parietal bone (Fig. 2a). We made an incision in his dura mater to release the intracranial hypertension and covered his brain tissue with turning-over of his dura mater onto the brain with the outside surface (Fig. 2b, c).