Neurosurgery in perilous area; is there any role of specialized field hospital in the management of low velocity penetrating head injuries?

Abstract

Back ground: Surgery for patient with penetrating head injury during war is debatable in literature. Field hospital with limited resources in war area could have a role in the management of this less devastating head injures patients. Methods: During a 6 months of Syrian civil war (October 2012- March 2013), 30 patients with low velocity penetrating head injuries was referred to a 3 different field hospitals managed by the same surgical team. The patient inclusion criteria were including Glasgow coma scale (GCS) ranged from 11 to 15, whom didn’t need for neuroscience intensive care unit (NICU) admission. Patients had laboratory and image before management decision. After surgery, the patient had short term admission before discharge and follow up at outpatient clinic. Results: The mean age for civil war victim was 26. ± 10.1and most of cases were males. All cases had penetrating metal shrapnel injuries from barrel bomb explosion. The majority of cases had GCS =15 (43.3%). Frontal lobe was the most frequent affected lobe (53.3%). The most frequent CT finding was contusion, edema and mass effects (60%). Surgery was reported in (83.3%) with no reported mortality. Surgical outcome was affected by pre hospital chronic illness P= 0.04 and, numbers of affected brain lobes by penetrating metal (P= 0.001). Conclusion: Surgical outcome of penetrating head injuries patients can be affected number of the affected brain lobes by penetrating metal and bone fragments. Field hospital in war area could be valid in the management of such patient.