Coşar A, Gönül E, Kurt E, Gönül M, Taşar M, Yetişer S
Department of Anaesthesiology, GATA Medical School, Etlik-Ankara, Turkey.
Minim Invasive Neurosurg. 2005 Apr;48(2):113-8. doi: 10.1055/s-2004-830222.
Four hundreds patients who suffered from cranial gunshot wounds injuries were analyzed. Surgical therapy, primary and secondary debridement, including repair of dural defects and removal of retained intracranial bone and metal fragments were applied. Central nervous system infections were mostly observed in cases with cerebrospinal fluid (CSF) fistulas. In 130 of 400 patients, bone and metal fragments were determined on control CT scans. Most of the deaths in this group of patients were attributed to the influence of brain injury and occurred within the first month after injury. Fragments retained after first debridement were followed periodically by CT scans. Surgery was not performed until the infection developed. Retained fragments did not increase the infection risk but high rates of infection did occur in cases with CSF fistulas. The presence of diffuse brain damage, brainstem injury, CNS infection, or ventricular injury was associated with a poor outcome. The prognostic importance of complications such as intracranial haemorrhage, epileptic seizures, hydrocephalus, was also investigated.
对400例颅脑枪伤患者进行了分析。采用了手术治疗、一期和二期清创术，包括修复硬脑膜缺损以及清除残留的颅内骨片和金属碎片。中枢神经系统感染大多发生在脑脊液（CSF）瘘的病例中。在400例患者中的130例中，通过对照CT扫描确定了骨片和金属碎片。该组患者的大多数死亡归因于脑损伤的影响，且发生在受伤后的第一个月内。首次清创术后残留的碎片通过CT扫描定期随访。直到感染发生才进行手术。残留碎片并未增加感染风险，但脑脊液瘘的病例确实发生了高感染率。弥漫性脑损伤、脑干损伤、中枢神经系统感染或脑室损伤的存在与不良预后相关。还研究了颅内出血、癫痫发作、脑积水等并发症的预后重要性。
