Craniocerebral Gunshot Wounds: Results of Less Aggressive Surgery and Complications

Abstract

Four hundreds patients who suffered from cranial gunshot wounds injuries were analyzed. Surgical therapy, primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments were applied. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. In 130 of 400 patients, bone and metal fragments were determined on control CT scans. Most of the deaths in this group of patients were attributed to the influence of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scans. Surgery was not performed until the infection developed. Retained fragments did not increase the infection risk but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome. The prognostic importance of complications such as intracranial haemorrhage, epileptic seizures, hydrocephalus, was also investigated.

Key words

Craniocerebral injury - prognostic factors - gunshot wounds - complications

References

• 1 Aarabi B. Comparative study of bacteriological contamination between primary and secondary exploration of missile head wounds.  Neurosurgery. 1987;  20 610-616
• 2 Aarabi B. Causes of infections in penetrating head wounds in the Iran-Iraq war.  Neurosurgery. 1989;  25 923-926
• 3 Brandvold B, Levi L, Feinsod M, George E D. Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict 1982 - 1985.  J Neurosurg. 1990;  72 15-21
• 4 Clark W C, Muhlbauer M S, Watridge C B, Ray M W. Analysis of 76 civilian craniocerabral gunshot wounds.  J Neurosurg. 1989;  65 9-14
• 5 Hammon W M. Analysis of 2,187 consecutive penetration wounds of the brain from Vietnam.  J Neurosurg. 1971;  34 127-131
• 6 Siccardi D, Cavaliere R, Pau A, Lubinu F, Turtas S, Viale G L. Penetrating craniocerebral missile injuries in civilians: A retrospective analysis of 314 causes.  Surg Neurol. 1991;  35 455-446
• 7 Hammon W M. Retained bone intracranial fragments: Analysis of 42 patients.  J Neurosurg. 1971;  34 142-144
• 8 Meirowsky A M. Secondary removal of the retained bone fragments in missile wounds of the brain.  J Neurosurg. 1982;  57 617-621
• 9 Pitlyk P J, Tolchin S, Stewart W. The experimental significance of retained intracranial bone fragments.  J Neurosurg. 1970;  33 19-24
• 10 Carey M E, Young H F, Rish B L, Mathis J L. Follow-up study of 103 American soldiers who sustained a brain wound in Vietnam.  J Neurosurg. 1974;  41 542-549
• 11 Hagan R. Early complications following penetrating wounds of the brain.  J Neurosurg. 1971;  34 132-141
• 12 Myers P W, Brophy J, Salazar A M. Retained bone fragments after penetrating brain wounds: long-term follow-up in Vietnam veterans.  J Neurosurg. 1989;  70 319
• 13 Taha J M, Saba M I, Brown J A. Missile injuries to the brain treated by simple wound closure: Results of a protocol during the Lebanese Conflict.  J Neurosurg. 1991;  29 380-384
• 14 Meirowsky A M, Caveness W F, Dillon J D, Rish B L, Mohr J P, Kistler J P, Weiss G H. Cerebrospinal fluid fistulas complicating missile wounds of the brain.  J Neurosurg. 1981;  54 44-48
• 15 Caveness W F, Meirowsky A M, Rish B L. The nature of posttraumatic epilepsy.  J Neurosurg. 1979;  50 545-553
• 16 Rish B L, Caveness W F, Dillon J D. Analysis of brain abscess after penetrating craniocerebral injuries in Vietnam.  J Neurosurg. 1981;  9 535-541
• 17 Hanieh A. Brain injury from a spent bullet descending vertically.  J Neurosurg. 1971;  34 222
• 18 Haynes W G. Penetrating brain wounds. Analysis of 342 cases.  J Neurosurg. 1945;  2 365
• 19 Rish B L, Dillon J D, Weiss G H. Mortality following penetrating craniocerebral injuries. An analysis of the deaths in the Vietnam head injury registry population.  J Neurosurg. 1983;  59 775
• 20 Allen M B, Miller R H. Essentials of neurosurgery. New York: McGraw-Hill 1995: 285
• 21 Ecker A D. A bacteriologic study of penetrating wounds of the brain from the surgical point of view.  J Neurosurg. 1946;  3 1-6
• 22 Walker A E, Erculei F. Head-injured men fifteen years later. Springfield, IIll: Charles C Thomas 1969: 10-11
• 23 Weiss G H, Canevess W F, Einsiedel-Lecktape H. Life expectancy and causes of death in a group of head injuries veterans of World War 1.  Arch Neurol. 1982;  39 741-743
• 24 Rish B L, Dillon J D, Weiss G H. Mortality following penetrating craniocerebral injuries.  J Neurosurg. 1983;  59 775-780
• 25 Adeloye A, Odeku E L. Epilepsy after missile wounds of the head.  J Neurol Neurosurg Psychiat. 1971;  34 98-103
• 26 Rapp R P, Norton J A, Young B, Tibbs P A. Cutaneous reactions in head-injured patients receiving phenytoin for seizure prophylaxis.  Neurosurgery. 1983;  13 272-275