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The article reports a case of a 28-year-old male with a ricochet gunshot injury to the skull and an associated left-hand wound. After emergency transport and surgical exploration with debridement and fragment removal, the postoperative course remained uneventful. The discussion emphasizes neurosurgical management trade-offs, including elevation versus preserving depressed fragments for tamponade, supported by a brief literature review.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/ricochet-penetrating-head-injury-a-case-report-and-brief-review-of-the-literature/464346/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/ricochet-penetrating-head-injury-a-case-report-and-brief-review-of-the-literature/464346.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are ricochet penetrating head injuries considered uncommon and challenging to manage?","Question",{"text":112,"@type":113},"They involve an atypical mechanism and can produce unpredictable trajectories with misleading external wounds. Management requires careful surgical decision-making to balance competing goals in wound and fracture handling.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What was done surgically in the reported case?",{"text":117,"@type":113},"Surgical exploration and debridement were performed, with accessible bullet fragments removed. The postoperative course was uneventful, and the patient was discharged in stable condition.",{"name":119,"@type":110,"acceptedAnswer":120},"How do the authors frame the main management dilemma for cranial ricochet injuries?",{"text":121,"@type":113},"They focus on whether to elevate cranial bone and reconstruct, or instead preserve depressed fragments as a natural tamponade to help control hemorrhage. A brief literature review is included to contextualize this dilemma.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},464346,1790814717,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Review began 12/30/2025  \nReview ended 01/07/2026  \nPublished 01/09/2026  \n© Copyright 2026  \nAlossaif et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.101179  \nOpen Access Case Report  \nRicochet Penetrating Head Injury: A Case Report and Brief Review of the Literature  \nManar Alossaif 1, Sultan Alsalmi 1 , Amenah Al Manasef 1 , Majed Alomair 1  \n1. College of Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU Corresponding author: Manar Alossaif, [alosaifmanar@gmail.com](alosaifmanar@gmail.com)  \nAbstract  \nRicochet gunshot injuries to the head represent an uncommon form of penetrating cranial trauma requiring careful surgical decision-making. We report the case of a 28-year-old male who sustained a ricochet gunshot injury to the skull with an associated left-hand wound. He was transported to the emergency department by the Red Crescent and arrived hemodynamically stable, alert, and oriented, with a Glasgow Coma Scale score of 15/15 . Surgical exploration and debridement were performed, and accessible bullet fragments were removed. The postoperative course was uneventful, and the patient was discharged in stable condition. This case highlights important neurosurgical considerations in the management of cranial ricochet injuries, particularly the balance between elevating the bone and preserving depressed fragments for potential tamponade. A brief review of the literature is included to contextualize management strategies and outcomes.  \nCategories: Neurosurgery  \nKeywords: frontal bone, gunshot, head injury, intracranial gunshot wound, ricochet bullet, saudi arabia  \nIntroduction  \nCivilian gunshot wounds to the head (GSWH) are a subtype of penetrating brain injury and are associated with a substantial burden of morbidity and mortality. This medical emergency carries a high fatality rate, with only approximately 10% of victims surviving long enough to reach the hospital. Among survivors, neurological deficits are frequently observed [1] .  \nRicochet projectile injuries constitute a distinct and uncommon mechanism of firearm injury, defined as \"the continued flight of a rebounded projectile and/or major projectile fragments after a low-angle impact with a surface or object \" [2] . Despite reduced velocity upon impact, ricochet bullets can still inflict substantial injuries and fatalities [3] . Nishshanka et al. [4] reported that most injuries result from misaimed bullets.  \nIn the Kingdom of Saudi Arabia (KSA), firearm ownership is regulated through strict licensing laws. Although comprehensive national data on firearm injury incidence are not publicly available, existing evidence indicates that there are 82/100,000 firearm-related deaths in KSA. Additionally, accidental and unintentional firearm injuries account for approximately 24% of firearm-related deaths [5] . In recent decades, the Houthi-Saudi Arabian conflict has contributed to an increase in firearm-related injuries presenting to the Najran region in KSA, with a mortality rate reaching up to 7.9%, the majority of which are attributed to head injuries [6] . Firearm incidents often lead to prolonged hospitalizations, with an average stay of 15 .45 ± 23.06 days (range: 1-150 days), reflecting their significant economic and social impact [7] . Head and chest injuries are among the most common and often fatal outcomes of firearm trauma in regions such as Dammam, KSA [8] .  \nRicochet bullets pose diagnostic and surgical challenges due to their unpredictable trajectories and potentially misleading external wounds [9] . Neurosurgical approaches to GSWH vary. Here, we present a rare case of a ricochet bullet penetrating the skull of a young male. We also review the literature to discuss the management dilemma of whether crania","cbCaiuJtR4qkutow","https://ap.wps.com/l/cbCaiuJtR4qkutow","pdf",3215950,"English","# Abstract\n# Introduction\n# Case Presentation\n# How to cite this article\n# Laboratory investigations\n# Imaging","[{\"question\":\"Why are ricochet penetrating head injuries considered uncommon and challenging to manage?\",\"answer\":\"They involve an atypical mechanism and can produce unpredictable trajectories with misleading external wounds. Management requires careful surgical decision-making to balance competing goals in wound and fracture handling.\"},{\"question\":\"What was done surgically in the reported case?\",\"answer\":\"Surgical exploration and debridement were performed, with accessible bullet fragments removed. The postoperative course was uneventful, and the patient was discharged in stable condition.\"},{\"question\":\"How do the authors frame the main management dilemma for cranial ricochet injuries?\",\"answer\":\"They focus on whether to elevate cranial bone and reconstruct, or instead preserve depressed fragments as a natural tamponade to help control hemorrhage. A brief literature review is included to contextualize this dilemma.\"}]","Ricochet Penetrating Head Injury - A Case Report and Brief Review of the Literature | PDF",1790768062,18]