• N Nathoo, H Boodhoo, S S Nadvi, S R Naidoo, and E Gouws.
• Department of Neurosurgery, Wentworth Hospital, School of Clinical Sciences, University of Natal, Durban, South Africa. nathoo@wwh.und.ac.za
• Neurosurgery. 2000 Nov 1; 47 (5): 1117-22; discussion 1123.

ObjectiveTranscranial stab injuries remain a frequent cause of emergent neurosurgical admissions to neurosurgical units in South Africa. Brainstem stabs are an uncommon, yet often fatal, form of brain injury.MethodsA retrospective audit of 597 patients with transcranial stab injuries admitted to our unit over a 12-year period (January 1987 to December 1998) identified 17 patients (2.85%) with brainstem stab injuries. The computed tomographic scans of all patients were analyzed, and a detailed autopsy examination of the skull and its contents was performed in all patients who died. Stepwise linear regression analysis was used to formulate a predictive model of outcome for the entire series of 597 patients.ResultsThe majority of the patients were males (16 patients), and the study group had a mean age of 28.65 +/- 9.59 years and a mean Glasgow Coma Scale score of 8.59 +/- 2.76. Knives (82%) were the most common instruments of penetration. Cerebral angiography identified 3 patients with vascular abnormalities, and autopsy revealed an additional 4 patients with vascular injury. Emergency ventriculostomy was performed in 10 patients for obstructive hydrocephalus. Four of the 17 patients survived (76.5% mortality). Factors significantly predictive of outcome in patients with transcranial stab injuries were the Glasgow Coma Scale score (F = 43.7), the occurrence of intraventricular hemorrhage (F = 22.8), the type of associated lesion (intracranial bleed, vascular abnormality, or brain abscess) (F = 5.9), and the number of operations (F = 3.2).ConclusionThe Glasgow Coma Scale score is the most significant predictor of outcome in low-velocity transcranial stab injuries. Brainstem stab injuries have a great propensity for vascular damage. Survivors are incapacitated by severe, fixed neurological deficits.

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