Prognostic factors in craniocerebral gunshot wounds: Analysis of 30 patients from the neurosurgical viewpoint

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.

Kranyoserebral ateþli silah yaralanmalarýnda prognostik faktörler: Nöroþirürji bakýþ açýsýndan 30 hastanýn analizi

AMAÇ: Kranyoserebral ateþli silah yaralanmalarý (KASY), kranyumun en ölümcül yaralanmalarýdýr. Çoðunlukla askeri çatýþmalara sekonderdir. Bu yaralanmalarýn ayrýca epilepsi, hidrosefali, enfeksiyon ve geç dönem biliþsel iþlev bozukluklarý gibi ciddi sonuçlarý da vardýr. Çalýþmamýzýn amacý, kliniðimizin KASY serisini sunmak ve bu yaralanmalarýn sonuçlarýný ve prognostik faktörlerini tartýþmaktýr.
GEREÇ VE YÖNTEM: 2011–2019 yýllarý arasýnda bölümümüzde KASY tanýsý ile tedavi edilen hastalar geriye dönük olarak incelendi. Yaralanma tipleri, yerleri, cerrahi tedavileri ve sonuçlarý analiz edildi. Radyolojik deðerlendirme de yapýldý.
BULGULAR: Otuz hasta KASY tanýsý ile tedavi edildi. Bunlarýn hepsi erkekti ve yaþ ortalamasý 27.9 idi. Frontal lob 12 (%40) hastada etkilenirken, sekiz hastada temporal lob, altý hastada oksipital lob, üç hastada parietal lob ve bir hastada posterior fossa etkilendi. Yirmi üç hastaya cerrahi tedavi uygulandý. On üç hasta (%43.3) cerrahi veya týbbi tedaviye raðmen kaybedildi.
TARTIÞMA: Kranyoserebral ateþli silah yaralarýnda ölüm oraný yüksektir. Ventriküler yaralanma, bihemisferik yaralanma, perforan yaralanma, beyin sapý hasarý ve baþvuru anýnda düþük GKS skoru prognostik faktörlerdir. Daha iyi klinik sonuçlar elde etmek için uygun ve doðru hasta yönetimi zorunludur.