Spontaneous movement of bullets in the interhemispheric region

Gunshot wounds to the head are usually mortal injuries. Their frequency has been increasing in the last years because of increasing crime and war rates. Penetrating craniocerebral injury in children and adolescents at the age of 17 or under is an increasing cause of emergent neurosurgical admissions to major metropolitan medical centers. I report a patient in whom a bullet in the brain moved from the interhemispheric region to 1 cm to the left of the inner occipital protuberance and midline. The patient recovered from surgery uneventfully. He was followed up for 4 years without neurodeficits. Spontaneous movement of bullets within the brain has been reported sporadically. The removal of intracerebral bullets is obviously warranted in patients undergoing craniotomy or craniectomy for debridement or evacuation of intracerebral clots or bone fragments if the metallic fragment is in proximity to the operative site. Before surgical removal of any intracerebral bullet, it is recommended that an intraoperative plain skull X-ray be obtained after final positioning of the head.