Civilian cerebral gunshot wounds: a South African experience

Kong, Victor; Odendaal, Jocinta; Sartorius, Benn; Clarke, Damian; Brysiewicz, Petra; Jerome, Ellen; Bruce, John; Laing, G L

doi:10.1111/ans.13846

Cited by 11 publications

(6 citation statements)

References 17 publications

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“…MRI is usually performed in the late period of injury to determine the size of brain damage, the presence of late brain abscess, or any focus or epilepsy. [4,18,22] It should not be forgotten that MRI is contraindicated in patients with metal fragments within the skull.…”

Section: Duraplasty 12mentioning

confidence: 99%

“…Craniocerebral gunshot wounds (CGW) are increasing medical problems in a military setting, as well as in civilian practice. [1][2][3][4][5] Especially in recent years, the increasing incidents of violence, civil wars and terrorism in cities have made CGW even more important. [6][7][8][9] These injuries are the most lethal form of all firearm injuries, and the treatment principles are still controversial.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Factors in Craniocerebral Gunshot Wounds: Analysis of 30 Patients from the Neurosurgical Viewpoint

Kirik

Yaşar

Durmaz

2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Craniocerebral gunshot wounds (CGW) are the most lethal injuries of the cranium. CGW is mostly secondary to military conflicts but may also be seen in civilian life. These injuries also have severe consequences, such as epilepsy, hydrocephalus, infection and late-term cognitive dysfunctions. The present study aims to present our series of CGW and to discuss the prognostic factors and consequences of these injuries. METHODS:The data of patients who were treated in our department for CGW between 2011 and 2019 were retrospectively reviewed in this study. The injury type, wounding site, surgical management and outcomes were analyzed. Radiological evaluation was also performed. RESULTS:Thirty patients were treated with the diagnosis of CGW. All of the patients were male and the mean age was 27.9 years. The frontal lobe was affected in 12 (40%) patients, while temporal lobe in eight, occipital lobe in six, parietal lobe in three, and posterior fossa in one patients. Twenty-three patients underwent surgical treatment, seven patients were treated conservatively. Thirteen (43.3%) patients died despite the treatment. CONCLUSION:Mortality in CGW is high. Ventricular injuries, bihemispheric or midline injuries, perforating injuries, brain stem injuries and low GCS score at admission are prognostic factors for CGW. Appropriate management is mandatory to obtain a better clinical outcome.

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Section: Duraplasty 12mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in Craniocerebral Gunshot Wounds: Analysis of 30 Patients from the Neurosurgical Viewpoint

Kirik

Yaşar

Durmaz

2020

Ulus Travma Acil Cerrahi Derg

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“…However, GSWB causing only lobar injury or limited degree of injury to deeper brain structures is survivable (Table 3 and refs. 6 , 11 , 17 , 26 ), and therefore, admission to intensive care surgical treatment should be considered. Although low GCS (≤ 8) is associated with poor outcome both in our prior literature and in our series, it is worth noting that in a multivariate model including transventricular bullet tract, low GCS on admission lost its significance.…”

Section: Discussionmentioning

confidence: 99%

“…However, GSWB leads to higher ICP and lower CPP than other mechanisms of brain injury [35], which suggests that salvageable GSWB patients would especially need neurointensive monitoring and care. Considering that the reported mortality rates of GSWB vary from < 10% to > 90% depending on the patients and injuries included in the studies [1, 6, 7, 11, 15, 16, 17, 18, 19, 20, 23, 24, 26, 33, 35], ICU admission of GSWB patients seems indicated since some of these patients survive their injuries. Moreover, in case the GSWB leads to brain death despite therapeutic efforts, many of these patients are potential organ donors and thus admission to the intensive care unit and ventilator treatment is justified even if the prognosis seems poor [5].…”

Section: Discussionmentioning

confidence: 99%

Outcome and rational management of civilian gunshot injuries to the brain—retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012

et al. 2019

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Background Treatment of gunshot wounds of the brain (GSWB) remains controversial and there is high variation in reported survival rates (from < 10 to > 90%) depending on the etiology and country. We retrospectively analyzed the outcome of a series of consecutive GSWB patients admitted alive to a level 1 trauma center in a safe high-income welfare country with a low rate of homicidal gun violence. Methods Patients admitted due to a GSWB to the HUS Helsinki University Hospital during 2000–2012 were identified from hospital discharge registry and log books of the emergency room and ICU. CT scans and medical records of these patients were reviewed. Univariate analysis and backward logistic regression were performed, and their results compared with that of a systematic literature review of factors related to the outcome of GSWB patients. Results Sixty-four patients admitted alive after GSWB were identified. Eighty percent had self-inflicted GSWB, 81% were contact shots, and 70% were caused by handguns. In-hospital mortality was 72%. Factors associated with mortality in our series were low GCS (≤ 8) at admission, transventricular bullet trajectory, and associated damage to deep brain structures, as reported before in the literature. Of the 64 patients admitted alive, 42% (27/64) were admitted to ICU, 34% (22/64) underwent surgery, and in 25% (16/64), craniotomy and hematoma evacuation was performed. Mortality in the surgically treated group was 32% but near 100% without surgery and ICU treatment. Median GOS in the surgically treated patients was 3 (range 1–5). Conclusions GSWB caused by contact shot from handguns has a high mortality rate, but can be survived with reasonable outcome if limited to lobar injury without significant damage to deep brain structures or brain stem. In such GSWB patients, initial aggressive resuscitation, ICU admission, and surgery seem indicated. Electronic supplementary material The online version of this article (10.1007/s00701-019-03952-y) contains supplementary material, which is available to authorized users.

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“…It has previously been reported that the risk of infection will increase, the success rate of operation will decrease and the risk of death will increase as this period increases. 32,33 In a South African study, delayed transport to hospital was associated with a high risk of death 34 ; even very short periods of time are of great importance for the survival of critically ill hypotensive patients. 35 There are some limitations of this study.…”

Section: Discussionmentioning

confidence: 99%

The effect of the delay between injury and surgery on mortality, morbidity, and complications in craniospinal gunshot wounding

Sertbaş

Karatay

2019

Trauma

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Introduction The effect of the surgical approach and the duration between the trauma and surgery on the complications, morbidity, and mortality in cranial and spinal penetrating gunshot injuries are investigated. Methods Evaluation of 63 patients from the Libyan civil war who were referred to the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital neurosurgery clinic for the treatment and surgery between 2015 and 2017. Results Complications such as meningitis, superficial infection, and abscess developed in 31% of the patients who underwent surgery within the initial 24 h, 58% of the patients who underwent surgery between 24 and 72 h and in all patients who underwent surgery after 72 h. While an improvement was seen in all 14 patients who had preoperative paresis and underwent surgery within 24 h or between 24 and 72 h, only one of the six patients who had paresis and underwent surgery after 72 h improved. One of the patients who underwent surgery within 24 h, three of those who underwent surgery between 24 and 72 h, and four of those who underwent surgery after 72 h died. Conclusion The complications, morbidity, and mortality increase with a prolonged duration between the injury and surgery after craniospinal gunshot wounding.

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Civilian cerebral gunshot wounds: a South African experience

Abstract: Cerebral gunshot wounds are associated with significant mortality and protracted delay to definitive care is common in our setting. Those who survive the delayed transfer to definitive care generally do well and have reasonably good clinical outcomes.

Cited by 11 publications

References 17 publications

Prognostic Factors in Craniocerebral Gunshot Wounds: Analysis of 30 Patients from the Neurosurgical Viewpoint

Prognostic Factors in Craniocerebral Gunshot Wounds: Analysis of 30 Patients from the Neurosurgical Viewpoint

Outcome and rational management of civilian gunshot injuries to the brain—retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012

The effect of the delay between injury and surgery on mortality, morbidity, and complications in craniospinal gunshot wounding

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