Outcome of Craniocerebral Penetrating Injuries: Experience from the Syrian War

Gunshot wounds to the brain are the most fatal of all firearm injuries. The aim of this study was to evaluate mortality and morbidity in patients with penetrating craniocerebral gunshot injuries and to identify risk factors that affect the outcome.

A retrospective review from June 2012 to November 2013 of 44 Syrian patients with gunshot wound to the head was performed. A thorough physical examination and computed tomography (CT) of the brain was obtained for all patients at the time of admission. Associated systemic injuries were found in 19 patients (43%). Surgical intervention was performed in 25 patients (57%); the remaining patients were managed conservatively. The patients were followed for a period of 1 to 15 months (range: 6 ± 2 months). Univariate analysis of patient age, sex, type of penetrating object, Glasgow Coma Scale (GCS) score and pupil size on admission, brain CT findings, presence of systemic injuries, and surgical intervention on the patient outcome was performed.

Eleven patients (25%) had a bullet injury; the remaining 33 (75%) patients had blast injuries. Initial brain CT revealed different types of skull fractures, intracerebral hemorrhage, and brain edema in all patients. The mortality rate during the follow-up period was 25%. Of the survivors, 25 patients (76%) had a good recovery, eight patients (24%) had a mild disability, and none had a severe disability. The significant factors determining outcome in this series were GCS on admission (p < 0.005) and positive pupil reaction to light (p < 0.05). The patient age, sex, CT findings, systemic injuries, neurosurgical intervention, and hospital length of stay were not significant prognostic factors (p > 0.05).

Among various variables, GCS and pupil reactivity were the outcome predictors in patients with penetrating craniocerebral injuries. Age, sex, type of penetrating object, CT findings, and surgical intervention did not have a significant effect on survival for these kinds of injuries.