Our experience with missile injuries to head in Department of Neurosurgery, Bir Hospital, Kathmandu, Nepal
AbstractA 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.
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