A 33-year-old male patient was brought to Amrita Hospital by his relatives with a gunshot injury on October 30, 2019. He was accidentally shot by his 10-year-old student friend from a distance of 3-4 feet with an airgun which resulted from an injury over the left temporal region, 2 cm anterior to triages of the left ear causing profuse bleeding. The patient was first taken to the nearest hospital in Trichur where his injury was evaluated. The CT brain plane showed a metallic foreign body consistent with a bullet lodged in the left temporal lobe with possible fragmentation adjacent to the entry site of the left temporal bone.  He was referred to Amrita Hospital for further treatment.

At Amrita Hospital, he underwent robotic guided endoscopic assisted surgery lead by Surgeon, Dr. Parasuraman A. of the Department of Neurosurgery, Amrita Institute of Medical Sciences, Kochi. It showed that the pellet was lodged close to the left side of the brain and there was no pseudoaneurysm involving intracranial blood vessels. The relatives were briefed in detail about the critical nature of the injury and possible neurological complications after the surgery. They were also told that it may not be possible to retrieve the pellet if there is a possibility of injury to the surrounding neurovascular structures. The consent for the surgery was obtained. He was then prepared for robotic guided endoscopic assisted surgery for retrieving of the pellet. After clearing pre-operative anesthesia evaluation, he underwent ROSA guided endoscopy assisted surgery on November 5, 2019.  It was done by making 3 inch small incisions in the skull. The gun pellet was successfully removed by ROSA.  After the surgery, he was shifted to ICU for neurological stability. And the visual and general health condition of the patient was also reported as normal. The endoscopic procedure done for the patient was successful and he was discharged within a few days.

 

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