Evaluation of Prognostic Factors in Patients with Cranial Gunshot Wounds

In recent years, cranial gunshot wounds become a growing concern for neurosurgeons due to factors such as the increase in civil wars, terrorist activities, and the global rise in civilian gun ownership.

To evaluate the prognostic factors in patients with cranial gunshot wounds.

The current study included 124 patients who received either conservative or surgical treatment for cranial gunshot wounds between October 2014 and April 2024. The data including age, gender, clinical parameters (Glasgow coma scale (GCS), pupillary examination, admission time, high or low-velocity gunshot injuries), radiological parameters (pattern of injury, presence of midline cross of the projectiles, affected brain lobes, presence of foreign body in the cranium, accompanying pathologies), and treatment parameters (treatment modalities, complications, and Glasgow outcome scale) were retrospectively collected.

The mean age of the patients was 26.29 ± 10.76 years (2-76 years). Sixteen patients (12.9%) were female, and 108 patients (87.1%) were male. Ninety-four patients (75.8%) had gunshot wounds related to Syrian civil war, 18 patients (14.5%) had accidental injuries, and 12 patients (9.7%) had suicide injuries. Higher initial GCS scores, isochoric pupils, low-velocity injuries, tangential injuries, the absence of midline cross of the projectiles, unihemispheric unilobar injuries, the absence of accompanying hematomas, and the lack of complications were statistically significantly correlated with favorable outcomes (P = 0.001). The overall mortality rate in the study cohort was 41.1% (51 patients). Fifty-five patients (44.4%) had favorable outcome, while 69 patients (55.6%) had poor outcome. Fifty-six complications were determined in 38 patients. Neurodeficits (32.1%), cerebrospinal fluid fistula and wound dehishence (21.4%), and systemic infections (21.4%) were primary complications.

In the present study, low initial GCS scores, fixed pupils, high-velocity injuries, perforating injuries, the presence of the midline cross of the projectiles, bihemispheric injuries, the presence of IVH, the presence of the complications, and the lack of surgical treatment showed statistically significant influence on mortality. Among these predictors, lower initial GCS scores, fixed pupils, midline cross of the projectiles, and complications were found to be the primary risk factors for mortality. Additionally, surgical treatment was found to reduce mortality rates.