Pediatric non missile penetrating head injury (NMPHI) is usually accidental attributed mainly to the softer skulls of growing children.

It is a rare entity and therefore no consensus exists regarding treatment, in order to effectively prevent the immediate and long-term complications. Throughout the literature practice, essentials are mostly discussed in case reviews and case series in general population. No data originating from randomized studies are available due to ethical and practical limitations.

Drosos et al. retrospectively studied and present 5 case files of children treated in the Neurosurgery Department of Children's Hospital “Aghia Sofia” due to NMPHI the past 6 years. Moreover, they performed a review of the literature in Pubmed, using the key words “non-missile”, “penetrating head injury” and “pediatric”. We included case reports and case series involving pediatric cases since 2008 and selected older reports, as well as certain literature reviews focusing on complications analysis and treatment suggestions. Finally, we compared reported practice in various institutions with current literature suggestions.

The last year, four literature reviews were published suggesting treatment algorithms of non-missile penetrating head injuries. Surgery timing and method as well as anticonvulsant and antibiotic therapy still remain debatable. The only review concentrating on pediatric populations dates back in 1994, based on patient outcome studies from 1980's. In our review, treatment steps were similar among various institutions resembling the recently suggested algorithms, with better treatment outcomes than originally reported 30 years ago ¹⁾.