Original ArticlesContemporary Management of Penetrating Brain InjuryEsposito, Domenic P. MD, FACS; Walker, James B. MDAuthor Information Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi Financial Disclosure: Neither of the authors has any financial or commercial interests in association with products or information mentioned in this manuscript. Proprietary Statement: Neither of the authors has any proprietary interests in association with products or information mentioned in this manuscript. No internal or external grants were received for this manuscript. Reprints: James B. Walker, MD, Department of Neurosurgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216 (e-mail: [email protected]). Neurosurgery Quarterly: December 2009 - Volume 19 - Issue 4 - p 249-254 doi: 10.1097/WNQ.0b013e3181bd1d53 Buy Metrics Abstract Penetrating brain injury includes all traumatic brain injury that is not the result of a blunt mechanism. Concerning these injuries, gunshot wounds are by far the most prevalent. Despite law enforcement efforts, these injuries unfortunately continue to be commonplace in large trauma centers as well as in metropolitan and large community emergency departments. Great efforts have been undertaken to standardize the medical and surgical management of these patients. The authors review the Guidelines of Penetrating Brain Injury published in 2001 and performed an updated literature search concerning this topic. There is evidence to suggest based upon current data that aggressive antibiotic prophylaxis and avoidance of aggressive debridement of deep-seated bone and bullet fragments has improved morbidity and mortality over the last 35 years. © 2009 Lippincott Williams & Wilkins, Inc.