A 52-year-old man was admitted after sustaining a gunshot wound to the head. The patient had been ambulant at the time of impact but collapsed suddenly and was comatose upon admission. Brain computed tomography (CT) scans revealed an acute subdural hematoma with marked midline shift; an emergency evacuation of the hematoma and craniectomy were performed. He recovered neurologically and underwent cranioplasty using autologous bone two weeks after the initial surgery, but he developed a wound infection and subdural empyema, necessitating another debridement surgery. Cranioplasty using a ceramic bone was performed two months after the debridement, and he was discharged with no neurological deficits. Gunshot wounds to the head have a higher rate of postoperative infection than closed head injuries; thus, debridement to remove as much bony and missile fragments as possible is important.
