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Self-inflicted gunshot wounds to the head during the war and post-war period
D Vranković1, B Splavski, I Hećimović
1Division of Neurosurgery, Osijek Clinical Hospital, Croatia.
Insights
This study on gunshot brain injuries found that surgical management improved survival, but patients with a Glasgow Coma Score of 3 had poor outcomes. Ultrasonography and CT scans aided in fragment removal and assessment.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Ballistics
Background:
- Self-inflicted gunshot brain injuries increased significantly during wartime.
- Firearm availability contributed to a rise in these severe injuries.
Purpose of the Study:
- To evaluate the management protocol for self-inflicted gunshot brain injuries.
- To identify prognostic factors and optimize surgical outcomes.
Main Methods:
- Surgical debridement of missile tracks and hematoma evacuation.
- Conservative management of in-driven bone fragments, with surgery for retained clusters.
- Use of ultrasonography and computed tomography (CT) for intraoperative and postoperative assessment.
- Monitoring for intracranial infections with contrast-enhanced CT.
Main Results:
- Twelve of 29 surgically managed patients survived, with follow-up up to 60 months.
- No cases of suicide recidivism were observed.
- Ultrasonography proved useful for localizing bone fragments; postoperative CT was essential for identifying retained fragments.
Conclusions:
- Patients with a Glasgow Coma Score of 3 are not candidates for surgical intervention.
- Aggressive surgical debridement and careful fragment management can improve survival rates.
- Advanced imaging techniques are crucial for effective treatment of gunshot brain injuries.
Abstract:
Thirty-five patients with self-inflicted gunshot brain injury were admitted to our hospital during 1991-96. War conditions and availability of firearms influenced the increase in these injuries, nearly six times greater than in the previous 6-year peace time period (1985-90). Our management protocol consisted of radical debridement of the missile track and evacuation of haematomata. For in-driven bone fragments we followed a less radical approach, but, if a post-operative computed tomogram (CT) showed a cluster of retained bone fragments, we operated on this. Attention was paid to the development of intracranial infection performing in such cases a contrast enhanced brain computed tomography. Ten patients died early and 29 were managed operatively. Twelve survived, and were followed-up for up to 60 months. No case of suicide recidivism was noted. We conclude that patients with a Glasgow Coma score of 3 should not be considered for operation. Per-operatively ultrasonography was very helpful in localizing and extracting in-driven bone fragments. Post-operatively, a CT scan is needed to demonstrate retained bone fragments.