{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:30:07Z","timestamp":1788280207319,"version":"build-2803163510"},"reference-count":64,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Penetrating brain injuries (PBIs) involving the sella region are rare, anatomically complex, and associated with high morbidity due to the proximity of critical neurovascular structures. Herein, the authors introduce a novel trajectory-based classification system derived from wartime injuries sustained during the conflict in Ukraine, aiming to improve the diagnostic framework, guide management strategies, and support prognostication in this unique population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a retrospective analysis of all PBIs involving an anatomically defined critically important sellar injury zone (CRISIZ) treated at a tertiary care center over a 2.5-year period (February 2022\u2013August 2024). Injuries were classified into 2 main categories based on projectile trajectory to the CRISIZ: transbasal (TB) and transcortical (TC). Each category was further subdivided into 4 anatomical subtypes. Clinical presentation, imaging characteristics, complications, treatment modalities, and outcomes were compared across subgroups. The primary outcome was the Glasgow Outcome Scale (GOS) score at 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 29 patients with PBIs involving the CRISIZ were identified (mean patient age 38 years). TB injuries were more common than TC by a factor of 1.6 (18 vs 11; 62.1% vs 37.9%). TB subtypes included transnasal, transorbital, transmaxillary, and infratemporal trajectories; TC subtypes included transfrontal, transtemporal, transventricular, and transoccipital. TB injuries had a higher prevalence of multiple projectile fragments (88.9% vs 45.5%, p &lt; 0.05) and CSF rhinorrhea (66.7% vs 18.2%, p &lt; 0.05). TC injuries were associated with significantly higher rates of intracranial vascular injury (81.8% vs 22.2%, p &lt; 0.01), subarachnoid hemorrhage, intraventricular hemorrhage, and coma on admission (54.5% vs 11.1%, p &lt; 0.05). Overall, in-hospital mortality was 10.3%, and 75.9% of patients achieved favorable outcomes (GOS scores &gt; 3) at 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Projectile trajectory is a critical determinant of injury pattern and clinical course in PBIs involving the CRISIZ. TC injuries are associated with a higher incidence of neurovascular complications, while TB injuries more commonly involve CSF leaks. Early identification and management of these complications are critical for optimizing outcomes. The proposed classification scheme provides a practical framework to guide evaluation and management in this high-risk patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.jns251191","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T12:00:17Z","timestamp":1769083217000},"page":"1487-1498","source":"Crossref","is-referenced-by-count":1,"title":["Wartime penetrating sellar\/parasellar injuries: a novel classification and management based on trajectory"],"prefix":"10.3171","volume":"144","author":[{"given":"Andrii","family":"Sirko","sequence":"first","affiliation":[{"name":"Center for \u0421erebral Neurosurgery, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vadym","family":"Perepelytsia","sequence":"additional","affiliation":[{"name":"Endovascular \u0421enter, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehsan","family":"Dowlati","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Northwell Health, Manhasset, New York;"},{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco","family":"Armonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital; and"},{"name":"Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"J Trauma","first-page":"11","article-title":"Isolated severe traumatic brain injuries sustained during combat operations: demographics, mortality outcomes, and lessons to be learned from contrasts to civilian counterparts","volume":"70","author":"DuBose JJ","year":"2011","unstructured":"DuBose JJ, Barmparas G, Inaba K,  Isolated severe traumatic brain injuries sustained during combat operations: demographics, mortality outcomes, and lessons to be learned from contrasts to civilian counterparts. 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Neurosurg Focus. 2018;45(6):E4."},{"issue":"5-6","key":"b4","series-title":"Mil Med","first-page":"e774","article-title":"Mortality and functional outcome predictors in combat-related penetrating brain injury treatment in a specialty civilian medical facility","volume":"185","author":"Sirko A","year":"2020","unstructured":"Sirko A, Pilipenko G, Romanukha D, Skrypnik A. Mortality and functional outcome predictors in combat-related penetrating brain injury treatment in a specialty civilian medical facility. Mil Med. 2020;185(5-6):e774\u2013e780."},{"issue":"5","key":"b5","series-title":"J Neurosurg","first-page":"1138","article-title":"Predictors of outcome in civilian gunshot wounds to the head","volume":"120","author":"Aarabi B","year":"2014","unstructured":"Aarabi B, Tofighi B, Kufera JA,  Predictors of outcome in civilian gunshot wounds to the head. 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Folia Morphol (Warsz). 2020;79(1):46\u201350."},{"issue":"Suppl. 1","key":"b8","series-title":"Acta Otorhinolaryngol Ital","first-page":"S30","article-title":"Sellar and parasellar lesions: multidisciplinary management","volume":"41","author":"Emanuelli E","year":"2021","unstructured":"Emanuelli E, Zanotti C, Munari S, Baldovin M, Schiavo G, Denaro L. Sellar and parasellar lesions: multidisciplinary management. Acta Otorhinolaryngol Ital. 2021;41(Suppl. 1):S30-S41."},{"issue":"5","key":"b9","series-title":"J Plast Reconstr Aesthet Surg","first-page":"645","article-title":"A novel classification of frontal bone fractures: the prognostic significance of vertical fracture trajectory and skull base extension","volume":"68","author":"Garg RK","year":"2015","unstructured":"Garg RK, Afifi AM, Gassner J,  A novel classification of frontal bone fractures: the prognostic significance of vertical fracture trajectory and skull base extension. 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