Wilder Penfield Lecture: nature and management of penetrating head injuries during the Civil War in Lebanon.

During the recent war in Lebanon- at one hospital one fifth of all casualty admissions were patients with skull injuries associated with penetrating brain damage. Wounds inflicted by high velocity missiles carried the greatest mortality. The patient's state of consciousness afforded the best guide to prognosis. Craniotomy, when feasible, was found preferable to the accepted technique of crainectomy in the management of these cases. Thorough débridement and complete hemostasis are essential, and when these have been accomplished, deeply placed bony fragments may be left in situ with impunity. Traumatic aneurysms develop by no means rarely and therefore postoperative arteriography is advisable.