Intracranial infection as a common complication following war missile skull base injury

The purpose of this paper is to stress the importance of clinical observation, the appropriate antimicrobial therapy, and early surgery in the management of intracranial infection following war missile penetrating skull base injury. There were 21 skull base missile injuries treated surgically in a 4-year period. Careful removal of devitalised brain tissue with dural closure was performed with all patients to prevent the development of intracranial infection. Subsequent clinical and radiological surveillance was performed to detect evidence of infection and abscess formation if fragments were left in place. Broad range antibiotic coverage, and the antioedematous agents were applied in the early postoperative period. Infection about the brain was seen in four cases. We recorded three cases of brain abscess formation, while one patient developed bacterial meningitis. The incidence of infectious complications was relatively high in our series. After the organisms causing infection were known, treatment was modified to be as specific as possible. It was not necessary to reoperate on intracranially retained foreign bodies and fragments since they did not increase the infection rate. However, repeated surgery is necessary for a brain abscess.