Early surgery and other indicators influencing the outcome of war missile skull base injuries

An Unusual Penetrating Craniocerebral Injury Due To Landmine Explosion: A Case Report

“…[1,2,5,10] In these injuries, bilateral hemispheric injuries, multilobar injuries, the presence of transventricular trajectory or brainstem injury, intracerebral hematoma with mass effect, and the existence of foreign body (bone, missile) usually indicate an unfavorable outcome and high mortality. [1,[6][7][8][9] Magnetic resonance imaging is usually less accessible, and in the case of intracranial metallic foreign body, it is contraindicated because of the potential risk for migration and further injury. Furthermore, magnetic resonance imaging may not provide adequate imaging of the bones.…”

“…[1,12] Intracerebral infection, CSF fistula, epileptic seizures, and loss of mental and motor function due to severe damage to the brain parenchyma are the common complications. [1,[3][4][5][6]15] Among them, infection is the most important complication. Rish et al [16] suggested that intracranial infection is the most common complication of penetrating missile injuries to the brain.…”

“…[1][2][3] The reported complications in these types of penetrating craniocerebral injuries, including those caused by landmines, include intracerebral hematoma, intracerebral infection, cerebrospinal fluid (CSF) fistula, epileptic seizures, and loss of mental and motor function. [1,[3][4][5][6] We present herein a 20-year-old male with a penetrating intracerebral giant shrapnel injury due to landmine.…”

High-Velocity Gunshot Wounds to the Head: Analysis of 135 Patients

“…17) Recently, the suggested treatment for missile or shrapnel head wounds has been divided into four groups: Large craniotomy or craniectomy and aggressive deep debridement, no surgical operation, minimal or superficial debridement, and simple debridement of the entrance gutter through a small craniotomy. 6,10,15,33,40) There is no consensus about the surgical indications or aggressiveness because of the great number of variables to be considered, such as the number and distribution of fragments, the occurrence of different types of lesions caused by different types of missiles and shrapnel particles, and the involvement of eloquent areas. Only superficial debridement of the entrance gutter and closure of the wound has been suggested.…”

“…1,9,18,19,38) However, the presence of retained fragments may have no relationship with the development of either infection or seizure disorder. 9,40) The role of surgery has not been precisely defined in the treatment of patients admitted with low GCS scores. Surgery was not performed in some patients with GCS scores 3 to 5, 12,19,22,24,29) because these patients have unfavorable outcome, even with surgical treatment.…”