1284 Intracranial Cerebrovascular Injury Associated With Pediatric Calvarial Gunshot Wounds

INTRODUCTION: Intracranial cerebrovascular injury (iCVI) is a rare but potentially devastating complication of gunshot wounds to the head (GSWH). Despite firearm injuries being the leading cause of death of children in the United States, the incidence, prognosis, and treatment of iCVI in pediatric patients has not been clearly described. METHODS: All pediatric GSWH from 01/2010 to 09/2023 at a large Level 1 trauma center in the southeastern US were retrospectively reviewed. Cases of injury to intracranial vasculature were identified. Demographics, injury patterns, treatments, and outcomes were collected. Statistical analyses were calculated using Fisher’s exact test and Friedman’s nonparametric Chi Square test where appropriate. A p-value of = 0.05 was considered significant. RESULTS: During the study period, there were 238 GSW to the head and face, with calvarial violation in 100 (42%) patients. Total incidence of iCVI was 18 (18%), and of these patients, 33.3% (6/18) suffered arterial injury, 44.4% (8/18) suffered venous injury (including sinus injury), and 22.2% (4/18) suffered both. iCVI was significantly associated with severe TBI (Glasgow Coma Score =8, p = 0.05). Ten (55.6%) patients with iCVI underwent repeat CT angiography, and 3 (16.7%) underwent catheter angiography. Four (22.2%) patients suffered radiographic vasospasm however none had radiographic stroke. Traumatic pseudoaneurysms requiring treatment were found in 2 patients (11.1%) at 12 days (received n-BCA embolization) and 4 years (received open trapping and excision) after injury respectively. Both patients with (55.6%) and without (62.2%) iCVI suffered a high mortality rate. CONCLUSIONS: iCVI is an important complication of GSWH, occurring in a non-insignificant portion of the pediatric population. While monitoring and treatment is limited by high up-front mortality, close attention to secondary vascular insult such as vasospasm and pseudoaneurysm formation is required.