Prognostic factors and management of civilian craniocerebral gunshot injuries; an institutional experience

Abstract

Introduction: Surgeons face unique challenge in the management & prognosis related issues with intracranial gunshot injuries. These injuries are more commonly seen in military conflict zone. With easy availaibility of weapon and increase in the conflict between civilian and paramilitiary forces, clinician are facing more numbers of civilian gunshot injuries. In India the presentation and prognosis of gunshot injuries is different as many of these gunshot injuries are by country made weapons. Country made weapons have low velocity and caliber; henceforth the outcome and the management issues are different. We present our experience with 23 patients who sustained intracranial gunshot injuries, and identify the factors determining the outcome and management Material and Methods: From March 2016 to September 2019 data was collected from 23 cases who were treated for intracranial gunshot injuries in Department of Neurosurgery at J. N. Medical College, Aligarh. History, type of weapon used, clinical condition and radiological findings were noted. Outcome was assessed by Glasgow’s Outcome scale. Results: Overall mortality was 26.08% (6/23). Of the 4 patients in GCS (3-7) group there was 100% mortality. Of the 5 patients in GCS group (8-12) mortality was 2 and one patient in persistent vegetative stage. All patients survived in GCS group (13-15). 5 patients underwent surgery; there was one mortality in the surgical group. Better outcome was noted in single lobe involvement and trajectory involving supratentorial noneloquent areas. Conclusion: Early aggressive resuscitative measures may help in better management. GCS at presentation is the most important factor affecting outcome. CT scan offers to be an important predictor of prognosis and also help in planning the management. Suicidal wound, hypotension and midline shift has poor prognosis. We don’t recommend aggressive exploration of the bullet tract & pellet removal for every patient. Keywords: Intrac