Our experience with missile injuries to head in Department of Neurosurgery, Bir Hospital, Kathmandu, Nepal
Abstract
A decade ago firearm injury was a rare incident in Nepal. As conflict started between Maoists and government forces the number of such injuries have been increasing day by day. This study is aimed at analysing the outcome of missile injuries of head after surgical management.This is a retrospective study of 37 patients who sustained missile injuries to head and underwent treatment at Department of Neurosurgery, Bir Hospital from June 2001 to October 2010. The follow up period ranged from 10 months to 9 years.Outcome was measured by Glasgow Outcome Score at 6 weeks and six months. There were 34 male and 3 female and age ranged from 5 to 50 years. On admission 7 patients had GCS of < 7, 13 patients had 8 - 12 and 17 patients had 13-15. 31 patients had only entry wounds and 6 patients had both entry and exit wound in the head.Two patients were treated conservatively and 35 patients underwent surgery. All patients had a course of intravenous antibiotics.Anticonvulsants were needed in 5 patients (13.5%) for seizures. Four patients died (10.8%) and 16 patients suffered postoperative complications. 25 patients (67.5%) had favourable outcome.This study suggests that GCS on admission and the extent of brain injury directly influence the outcome of missile injuries to the head. A standard wound debridement along with watertight dural closure appears to minimize postoperative wound infection.References
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27. Caveness WF, Meirowsky AM, Rish BL, et al. The natureof post-traumatic epilepsy. J Neurosurg 1979; 50 (5): 545-553.
28. Cooper P. Gunshot wounds of the brain. In cooper p(ed): Head Injury, 3rd ed. Baltimore : Williams and Wilkins, 1993.
29. Kaufman HH. Treatment of civilian gunshot wounds tothe head. Neurosurg Clin N Am 1991; 2(2): 387-397.
30. Sherman WD, Apuzzo MLJ, Heiden JS, et al. Gunshotwounds to the brain – a civilian experience. West J Med 1980; 132: 99-105.
31. Kaufman HH, Makela ME, Lee KF, et al. Gunshot woundsto the head. A perspective. Neurosurgery 1986; 18: 689695.
32. Narayan RK, Contant CF, Russel KD, et al. Gunshotwounds to the head: lesions from a 9 year civilian experience. Paper presented at the Scientific programme, both annual meeting of the American Association of Neurological Surgeons. 1992, Sanfranscico, pp 367.
33. Grawande A. Casualties of war – military case for thewounded from Iraq and Afghanistan. N Engl J Med. 2004;351: 2471-2475.
34. Cavey ME, Young HF, Rish BL, et al. Follow up study of103 soldiers who sustained a brain wound in Vietnam. J Neurosurg 1974; 41:542-549.
35. Rish BL, Dillon JD, Weiss GH. Mortality followingpenetrating craniocerebral injuries; An analysis of death in the Vietnam Head Injury Registry population. J Neurosurg 1983; 59: 775-80.
2. Rosenberg WS, Housh VI GR. Penetrating wound of the head. In. Wilkins RH, Rangacharya SS (ed). Neurosurgery 2nd edition vol. II - McGraw - Hill, New york, 1996; pp 2813-2820.
3. De Villier SJ. The management of missile injuries of the head during the Anglo - Boer war. Br. J Neurosurg 1987; 1:53-61.
4. Cushing H. A study of a series of wound involving the brain and its involving structures. Br J surg. 1918; 5: 558-684.
5. Cushing H. Notes on penetrating wounds of the brain. BMJ 1918; 1:221-226.
6. Haynes W. Penetrating brain wounds. Analysis of 342 cases. J Neurosurg 2: 365-378, 1945.
7. Selmon H. Forward Neurosurgery in Italy. J Neurosurg 1945;2: 332-339.
8. Lewin W. Missile head wounds in Korean campaign : A survey of British casualties. Br J Surg 1956; 43: 628-632.
9. Frevtag E. Autopsy findings in head injuries from five arms. Arch Pathol 1963; 76:215-225.
10. Raimondi AJ, Samuelson GH. Craniocerebral gunshotwounds in civilian practice. J Neurosurg 1970;32:647653.
11. Lillard PL. Five years experience with penetratingcraniocerebral gunshot wounds. Surg Neurol 1978; 9: 79-83.
12. Cooper PR, Maraville K, Cone J. Computerisedtomographic findings. Neurosurgery 1979; 4: 373-380.
13. Shoung HM, Sichez JP, Pertuiset B. The early prognosisof craniocerebral gunshot wounds in civilian practice as an aid to the choice of treatment. A series of 56 cases studied by computerized tomography. Acta Neurochir (Wien) 1985; 74: 27-30.
14. Aldrich EF, Eisenberg HM, Saydjari C, et al. Predictorsof mortality in severely head injured patients with civilian gunshot wound. A report from the NIH Traumatic Coma Data Bank. Surg Neurol 1992; 38(6): 418-423.
15. Nagib MG, Rockswold Gl, Sherman RS, et al. Civiliangunshot wounds to the brain – prognosis and management. Neurosurgery 1986; 18 (5): 533-537.
16. Grahm TW, Williams FC, Harrington T, et al. Civiliangunshot wounds to the head. A prospective study. Neuosurgery 1990; 27: 696-700.
17. Levy MC, Marsi LS, Lavine S, et al. Outcome predictionafter penetrating craniocerebral injury in a civilian population: aggressive surgical management in patients with admission GCS of 3,4,5. Neurosurgery 1994; 35: 77-85.
18. Helling TS, MCNabney WK, Whittaker CK, et al. Therole of early surgical intervention in civilian gunshot wounds to the head. J Trauma 1992; 32: 398-401.
19. Bradvold B, Levi L, Feinsod M, et al. Penetratingcranocerebral injuries in the Israeli involvement in the Lebanese conflict. 1982-195: Analysis of a less aggressive surgical approach. J Neurosurg 1990; 72 (1): 15-21.
20. Rish BL, Caveness WF, Dillon JP, et al. Analysis of brainabscess after penetrating craniocerebral injuries in Vietnam. Neurosurgery 1981; 9 (5): 535-541.
21. Whitaker R. Gunshot wound of cranium : with specialreference to those of brain. Br J Surg 1916; 3: 708-735.
22. Aarabi B. Surgical outcome in 435 patients whosustained missile head wounds during the Iran – Iraq war. Neurosurgery 1990; 27: 692-695.
23. Avendal RE, Meirowsky AM. Air sinus wounds : Ananalysis of 163 consecutive cases incurred in the Korean war, 1950-1952, Neurosurgery 1983; 13 (4): 377-380.
24. Brain Trauma Foundation : Guidelines for themanagement of severe head injury. Joint initiative of the Brain Trauma Foundation, the American Association of Neurological Surgeons, and the joint section on Neurotrauma and critical care, 1995.
25. Temkin NR, Dikmen SS, Wilensky AJ, et al. A randomizeddouble blind study of phenytoin of posttraumatic seizures. N Engl J Med 1990; 323: 497-502.
26. Salazar AM, Jabbari B, Vance SC, et al. Epilepsy afterpenetrating head injury 1: clinical correlates : A report of Vietnam head injury study. Neurology 1988; 35 (10): 1406-1414.
27. Caveness WF, Meirowsky AM, Rish BL, et al. The natureof post-traumatic epilepsy. J Neurosurg 1979; 50 (5): 545-553.
28. Cooper P. Gunshot wounds of the brain. In cooper p(ed): Head Injury, 3rd ed. Baltimore : Williams and Wilkins, 1993.
29. Kaufman HH. Treatment of civilian gunshot wounds tothe head. Neurosurg Clin N Am 1991; 2(2): 387-397.
30. Sherman WD, Apuzzo MLJ, Heiden JS, et al. Gunshotwounds to the brain – a civilian experience. West J Med 1980; 132: 99-105.
31. Kaufman HH, Makela ME, Lee KF, et al. Gunshot woundsto the head. A perspective. Neurosurgery 1986; 18: 689695.
32. Narayan RK, Contant CF, Russel KD, et al. Gunshotwounds to the head: lesions from a 9 year civilian experience. Paper presented at the Scientific programme, both annual meeting of the American Association of Neurological Surgeons. 1992, Sanfranscico, pp 367.
33. Grawande A. Casualties of war – military case for thewounded from Iraq and Afghanistan. N Engl J Med. 2004;351: 2471-2475.
34. Cavey ME, Young HF, Rish BL, et al. Follow up study of103 soldiers who sustained a brain wound in Vietnam. J Neurosurg 1974; 41:542-549.
35. Rish BL, Dillon JD, Weiss GH. Mortality followingpenetrating craniocerebral injuries; An analysis of death in the Vietnam Head Injury Registry population. J Neurosurg 1983; 59: 775-80.
Published
2015-03-19
How to Cite
SHARMA, G R; BISTA, P; SULTANIA, P K.
Our experience with missile injuries to head in Department of Neurosurgery, Bir Hospital, Kathmandu, Nepal.
J Soc Surg Nep, [S.l.], v. 14, n. 2, mar. 2015.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=21>. Date accessed: 01 dec. 2023.
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