SUMMARYThe management of 93 patients with craniocerebral gunshot wounds is reviewed. The contrast between the injuries of urban guerilla warfare, conventional warfare and civilian life is outlined. Emphasis is placed on the need for early and adequate transfusion and for immediate airway control to limit cerebral oedema. Principles of wound surgery evolved in other conflicts were followed and developed.CEREBRAL gunshot wounds differ from other types of head injury. The initial damage is often focal; even when both cerebral hemispheres are affected the level of consciousness is often surprisingly light, but spreading cerebral oedema, if unchecked, leads rapidly to severe generalized brain damage.When a bullet strikes the body the effect depends partly on the kinetic energy of the bullet and partly on its size and shape. As kinetic energy is a function of the mass of the bullet and the square of its velocity ( E = +mu2), it follows that even a small high velocity bullet will carry much more energy than a larger one of low velocity. A high velocity bullet travels faster than the speed of sound

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The case is presented of an intraspinal meningioma in a 14-yr-old female. After surgical exploration pulmonary metastases became apparent. At necropsy the tumour had increased proportions of the cathodal isoenzymes LDH-4 and 5. This pattern has previously been observed in malignant meningiomas and may be used at the time of biopsy to assess malignancy.