RESULTS OF BRAIN INJURY PRIMARY SURGICAL TREATMENT IN A COMPLEX CARE FOR PATIENTS WITH COMBAT-RELATED PENETRATING...

The aim of the study is to justify the "balanced" approach to brain debridement (BD) in surgical treatment of combat-related penetrating craniocerebral gunshot wound (PCGW) patients and assess immediate and long-term treatment results. The analysis of applied surgical BD techniques was performed in PCGW military personnel with admission Glasgow Coma Scale (GCS) score of 4 or above. The study included 81 injured patients. Average GCS score at admission was 10±3. Blunt injuries were predominant (n=51, 62.9%). Bone fragments were removed in 78 (92.8%) and metal foreign bodies were removed in 32 (38.1%)cases. Demographic and clinical characteristics, nature of brain injury, presence of foreign bodies and depth of their location, surgery extent, and occurrence of complications in postoperative period were taken into account. The outcome data included a Glasgow Outcome Scale (GOS) score at discharge, in 6 and 12 months, grade of speech disorders, extremities strength, and occurrence of convulsive attacks from the time of admission to 12 months. Meningitis developed in 11 (13.6%) cases. 11 (13.6%) patients died. Good recovery (GOS score 4-5) in 12 months was in 8 (38.1%) patients, moderate disability (GOS score 4) in 10 (47.6%) patients. Adverse outcome (GOS score 1-3) was associated with axial dislocation (p=0.015), diametric wound (p<0.001), and purulent-septic complications (PSC) (p<0.05). Intracranial PSCs are statistically significantly associated with duration of subdural space inflow and outflow drainage of 4+ days (p<0.05), bone fragments left in the brain matter (p=0.008), and ventricular hemorrhage on HCT (p=0.016). The choice of a BD technique depended on severity of patient's condition, brain injury, and presence of foreign bodies. Availability of an equipped operating room allowed for thorough surgery. Good outcome indicators testify to appropriateness of the chosen tactic.