1 3 DOI 10.1007/s00068-014-0481-9 Eur J Trauma Emerg Surg ORIGINAL ARTICLE Penetrating shrapnel injuries of the posterior fossa M. Seçer · M. Ulutas¸ · F. Alagöz · K. Çınar · E. Yayla Received: 22 March 2014 / Accepted: 18 November 2014 © Springer-Verlag Berlin Heidelberg 2014 one case. Following preoperative procedures, surgery was performed with the patient in the prone position. Postop- erative monitoring revealed no CSF fistula, meningitis, or hydrocephalus. None of the patients required revision sur- gery. There were no postoperative mortalities. Conclusion Due to the small volume of the posterior fossa, acute pathologies may lead to rapid neurological deterioration and death. Early surgical intervention and close postoperative follow-up after penetrating shrapnel injuries of the posterior fossa play a significant role in reducing mortality and morbidity. Keywords Posterior fossa · Penetrating trauma · Shrapnel · Surgery Introduction Traumatic brain damage caused by gunshot injuries leads to high rates of mortality and morbidity [1]. In cranial pen- etrating gunshot injuries, low GCS scores, bilateral hemi- spheric injury, multiple lobe injury, transventricular injury, intracerebral hematoma, and contusion with mass effect are poor prognosis criteria [2]. Cranial gunshot injuries can be tangential, perforating, or penetrating injuries [3]. Cranial gunshot wounds reported in the literature include ventricular injury [4], penetrating orbitocranial injury [5], metallic and nonmetallic injury [6], skull base injury [7], and infratentorial injury [2]. In the current study, four cases of penetrating shrapnel injury of the pure posterior fossa caused by a barrel bomb explosion were evaluated. A liter- ature search of PubMed with the keywords “foreign body” [AND] “intracranial injury” yielded 573 articles. However, none of those articles included presentation of shrapnel injury by barrel bomb. Abstract Background Gunshot injuries of the posterior fossa are rare and may follow a fatal course. In posterior fossa gun- shot injuries, cerebellar hematoma, contusion, obstruction of cerebrospinal fluid (CSF) circulation by the shrapnel, and intracranial hypertension caused by autoregulation loss lead to mortality in the early stage. Methods In this study, four cases of patients who under- went surgical intervention after penetrating shrapnel inju- ries of the pure posterior fossa were evaluated. Results All of the patients were male; their mean age was 26.5 ± 5 years. The lowest and highest Glasgow Coma Scale scores were 4 and 12, respectively. Neural injury was detected by computed tomography performed after sys- temic and neurological examination following admission to the emergency service. The shrapnel was found in the cerebellar tissue in three cases and in the fourth ventricle in This study has been presented as an electronic poster at the 28th Scientific Congress of the Turkish Neurosurgical Society. M. Seçer (*) Department of Neurosurgery, Deva Hospital, Osmangazi mah. 14 nolu Cadde 162/1 S¸ehitkamil, Gaziantep 27560, Turkey e-mail: memetsecer@yahoo.com M. Ulutas¸ Department of Neurosurgery, Sanko Hospital, Gaziantep, Turkey F. Alagöz Department of Neurosurgery, Ankara Numune Educational and Training Hospital, Ankara, Turkey K. Çınar · E. Yayla Department of Neurosurgery, S¸ ehitkamil State Hospital, Gaziantep, Turkey