Endoscopic interventions for gunshot craniocerebral injuries

Full-endoscopic (neuroendoscopic) removal of foreign bodies from the cranial cavity is a relatively new technique with limited information available in the literature. Compared to open surgeries, this minimally invasive approach is associated with less impact on the surrounding brain tissues and fewer complications. The safety of such procedures is enhanced by the use of CT navigation. This article describes the surgical technique of endoscopic removal of metallic fragments in combat-related gunshot cranial injuries, based on five clinical cases, and presents the results of a systematic literature review. Objective. To evaluate the capabilities and effectiveness of fully endoscopic surgery in combat-related gunshot cranial injuries and to compare the obtained results with the data available in the global literature. Material and methods. In the neurosurgery clinic of the Military Medical Academy named after S.M. Kirov, from March 2023 to June 2024, 5 patients with shrapnel wounds to the head underwent removal of foreign bodies using endoscopic techniques. The databases of scientific publications PubMed, Google Scholar, and eLibrary searched for publications in accordance with the rules of systematic review, and 12 articles were found that fully meet the search criteria. Results. All 5 patients were successfully operated using endoscopic techniques. Endoscopic rehabilitation of a gunshot wound is an optional minimally invasive neurosurgical procedure and can be effectively applied in a specialized hospital to remove foreign bodies localized deep in the brain, ventricles, and base of the skull, with a high risk of their removal during primary surgical treatment or its non-radical implementation.