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

Abstract

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.

Patterns of War-Related Traumatic Brain Injuries and Predictors of Mortality Among Civilians During the Syrian Armed Conflict

“…The tendency of shrapnel injuries to occur in the frontal and parietal lobes in our patients is in line with previous studies, 8,16,17,21,22 which suggested a higher predisposition of the frontal lobes because of their large size and anterior location. Surprisingly, the frequency of gunshot injuries in the parietal lobes of our sample was higher compared with those in the existing literature in armed personnel.…”

“…In addition to loss of brain material, hemorrhages of intracerebral, intraventricular, or subdural etiologies predicted mortality. These findings confirmed previous studies that reported poor outcomes for patients with ventricular damage 16,36-38 and intracranial hemorrhage. 39,40…”

“…This is in line with previous studies that showed higher mortality from injuries to the brain stem and parietal lobes and injuries that pass the ventricles. 8,16,22,35 In contrast, Can et al 23 reported higher mortality in temporal injuries, which might be more specific for his sample that included only sniper head injuries. Finally, the site of injury in our sample could solely explain about 14% of the variability in mortality.…”

“…14 Regarding the site of injury, the frontal lobe was the most commonly affected site, whereas the posterior fossa and brainstem are least affected. 15-17…”

“…14 Regarding the site of injury, the frontal lobe was the most commonly affected site, whereas the posterior fossa and brainstem are least affected. [15][16][17] Mortality rates because of penetrating TBIs vary significantly between countries, reaching up to 93% in some circumstances. 11,18 Several injury characteristics can predict poor outcomes such as injuries associated with mass effect, diffuse intracerebral hematomas, multilobar injuries, ventricular system or brain stem involvement, and crossing bullets.…”