Outcome of Craniocerebral Gunshot Injuries in the Civilian Population. Prognostic Factors and Treatment Options

Abstract

Patients with a GCS of 3-8 and two non-reactive pupils should not be operated. If one or both of the pupils are reactive, surgery should be performed irrespective of the GCS score, except in patients with translobar/transventricular wounds. Even if there are no clear contraindications to surgery, the outcome is expected to be poor in patients with a low GCS score, midline shift >10 mm, >2 bone fragments in the brain, and a bilobar, posterior fossa/brainstem or ventricular lesion and ICP >45 mmHg. When surgery is performed the wound and the missile or bone track should be debrided meticulously, the wound and dura should be closed in a watertight fashion and antibiotic prophylaxis as well as tetanus serum should be given.

Surgical management of civilian gunshot wounds to the head

“…In the Iran-Iraq War, operated and unoperated patients were received at the emergency department of a tertiary hospital after a mean of 49 hours (Aarabi, 1990). The second clinical predictor of outcome is the status of the pupillary size and reaction to light (Aarabi, 1990;Brandvold et al, 1990;Grahm et al, 1990;Murano et al, 2005;Glapa et al, 2009;Hofbauer et al, 2010;Petridis et al, 2011;Ambrosi et al, 2012). In the literature on civilians with GSWH, the percentage of patients with a GCS of 3-8 ranges from 48% to 94% (Kaufman et al, 1983;Clark et al, 1986;Mancuso et al, 1988;Grahm et al, 1990;Shaffrey et al, 1992;Kennedy et al, 1993).…”

Emergency lateral canthotomy and cantholysis to relieve intraocular pressure following severe motor vehicle collision

“…1 With evidence of head trauma, non-reactive pupils have long been observed as a strong predictor of both neurological injury and mortality. [2][3][4] Emergency lateral canthotomy and cantholysis to relieve intraocular pressure following severe motor vehicle collision Jason L Elzinga, Herman Bami Faculty Reviewer: Robert Leeper, MD, FRCSC, FACS (Department of Surgery, Division of General Surgery)…”

Suicide with One Cranial Gunshot by a .320 Caliber Pocket Revolver

“…Handguns are the most frequently used weapons in suicides, mainly by contact shot to the head (81%), the chest (17%), and the abdomen (2%); the most common location is the right temple region [4,5]. The mortality of the related cranial injury is very high, ranging from 20% to 90%, with a poor outcome in bilobar lesions [6].…”