Penetrating craniocerebral injuries from the former Yugoslavia battlefields

Abstract

In the period from September 10 th 1991 to December 31 st 1992, the total of 162 patients with penetrating craniocerebral war injuries from the former Yugoslavia battlefields were treated in the Military Medical Academy (MMA) in Belgrade. The severity of injury was graded according to the Glasgow Coma Score (GCS) as mild (13–15), moderate (9–12), and severe (3–8). The extensity of the cerebral lesion was classified as unilobar, multilobar, bihemispheric, transventricular, and haematoma with shift. Injuries were divided into those caused by bullets or shrapnel. According to the missile path, these were tangential, uncrossed, and crossed injuries. The patients were divided into the two groups according to the treatment that they received: Group A- 90 patients who were referred directly to the MMA without surgical treatment, and group B-72 patients who were treated surgically (minimal debridment or simple wound closure) in the local hospitals before the evacuation to the MMA. The outcome was assessed on the discharge from the MMA according to the Glasgow Outcome Scale (GOS). Severe penetrating injuries had poor outcome as compared to moderate and mild injuries (p=0.001). Multilobar and bihemispheric injuries as compared to unilobar, and crossing as compared to uncrossing or tangential injuries had a poor outcome (p=0.001). Bullet injuries had a poor outcome then shrapnel injuries (p=0.016). For the treatment of the complications or additional debridement 6.5% patients from the group A and 78% from the group B were reoperated. There was no statistically significant difference regarding the final outcome of the patients from the group A comparing to the group B (p = 0.169). Severity of the injury, extensity of the cerebral lesion, the missile path, and the type of missile significantly influenced the final outcome. Minimal debridement of penetrating gunshot injuries was not a sufficient solution because it required a high rate of reoperation in the later stage.