Incidence, Hormonal Distribution and Postoperative Follow Up of Atypical Pituitary Adenomas

Air guns (AGs) are arms that use air or another compressed gas to propel a projectile. Generally, brain injury may occur in children due to their incomplete skull development;however, the less-resistant and thin region of the skull in adults may also be penetrated by an AG shot. In this paper, we present three adult cases treated in our clinic for brain injury caused by an AG. The first case had brain and skull damage related to the high pressure of the compressed gas, and the others additionally had foreign bodies in their brain. All of the patients were operated. Two were discharged without neurological deficit; the third case had a permanent slight hemiparesis. Average follow-up was 11 months and no abscess formation was observed in this period. AGs are known as low-velocity arms; however, they have the potential to cause brain injury, and brain penetration may occur especially in the relatively less resistant and thin sites of the skull such as the orbit and temporal and occipital bones. As cerebrospinal fluid leakage is one of the expected conditions, urgent surgery is usually required.

Havalı silahlar basınçlı hava veya diğer gazların kullanılarak hızla boşaltılması ile çalışır. Genellikle kafatası tamamıyla gelişmemiş çocuklarda beyin hasarı görülmekle birlikte erişkinlerde daha az dirençli ve ince bölgelerinden kafatasını delerek beyin hasarına yol açabilir. Bu yazıda, havalı silah yaralanması sonucu beyin hasarı olan ve tedavi edilen üç erişkin olgu sunuldu. İlk olguda yüksek basınçlı gazın etkisine bağlı kafatası ve beyin hasarı, diğer olgularda ek olarak yabancı cisme nedeniyle beyin hasarı saptandı. Tüm olgular ameliyat edildi, iki olgu nörolojik kaybı olmaksızın taburcu edildi, üçüncü olgu hafif hemiparezi ile taburcu edildi. Ortalama 11 aylık izlemde olgularda beyin apsesi gelişimi gözlenmedi. Havalı silahlar düşük hızlı silahlar olarak bilinirler, ancak beyin hasarına neden olabilirler, özellikle ince ve daha az dirençli bölgeler olan orbita, temporal ve oksipital kemikleri delerek beyin hasarına yol açabilirler. Beyin-omurilik sıvısı kaçağı genellikle beklenen bir durum olup acil cerrahi tedavi gereklidir.

Air guns (AGs) are arms that use air or another compressed gas to propel a projectile, such as a ballbearing or pellet.[1] AG weapons have been used for over 400 years since their production in the middle of the 16th century.[2] The new models of AGs are more powerful and are capable of producing severe damage.[ 1,3] These can develop a muzzle velocity of 330 to 340 ft/sec, which exceeds the impact velocity of 150 to 170 ft/sec required to pierce the skin, and which approaches the additional 200 ft/sec required for bone penetration.[4] However, AGs can be modified to increase the damage caused by the pellet.[1,2]

The head, neck and eyes are the areas of the body most frequently injured by AG shots.[1,2,4,5] Much has been published on the effects of AG pellets penetrating sensitive organs, particularly the eyes, but fewer fatal cases have been reported.[6-8] The majority of fatal incidents reported have involved children and adults. [1,3,5] Pellets have entered through the eyes, temple or forehead, and then penetrated the brain.[1,3,4,6,7] In this paper, we present three cases of AG injuries with brain damage and also briefly review the management and follow-up of this type of injury.