Penetrating Cranio-Cerebral Gunshot Injury with Retained Intracranial Bullet Adjacent to the Superior Sagittal Sinus

Penetrating gunshot injuries to the head are among the most severe forms of traumatic brain injury and are associated with high morbidity and mortality. This case report describes a 40-year-old female who presented to the emergency department 2 hours after sustaining a penetrating cranio-cerebral gunshot injury. The patient experienced loss of consciousness at the time of injury. On admission, with a Glasgow Coma Scale score of 10/15 and no focal neurological deficits. Vital signs were stable.Non-contrast head CT of the brain revealed a retained bullet in the parietal lobe without evidence of intracranial hemorrhage, mass effect, or midline shift, although image interpretation was limited by metallic artifact. The patient underwent an emergency craniotomy for removal of the retained intracranial bullet. Extreme caution was exercised to preserve the superior sagittal sinus and avoid vascular injury during the procedure. The surgery was completed without complications, and the patient was subsequently monitored in the intensive care unit). Follow-up CT imaging confirmed complete bullet removal and preservation of the superior sagittal sinus. Clinically, the patient showed neurological improvement, with her GCS increasing to 15/15.

This case highlights the importance of early clinical stabilization, rapid neuroimaging, and timely neurosurgical intervention in improving outcomes following penetrating cranial gunshot injuries. Favorable neurological recovery can be achieved through surgical planning and timely intervention, even when a retained intracranial bullet is located in close proximity to critical neurovascular structures.