Analysis of 127 war inflicted missile brain injuries sustained in north-eastern Croatia.

During the 4-year period (1991-1994) there were 127 consecutive patients with missile brain wound treated at the Division of Neurosurgery. They sustained brain injury in the region of east Slavonia, Baranya and north Bosnia, and were admitted mostly during the homeland defensive war in Croatia (1991-1992). Analysing the wounded, we divided them in two groups: "succumbed" (59 wounded) and "survivors" (68 wounded). We applied "less radical type of surgery", i.e. the patients were never re-operated only because of the retained single bone fragment. However, a retained cluster of bone fragments should be reoperated. The higher percentage of retained bone fragments (76.8%) is the result of precise visualization on the postoperative computed tomography (CT) scan. The last few cases have convinced us that the problem of the retained fragments could be solved by using an intraoprative ultrasonography. An intracranial (i.c.) infection (meningitis, abscess) occurred in 10 patients (10%), mostly among the patients who, besides the retained fragments, had cerebrospinal fluid (CSF) leak on the dehiscenced scalp wound. These cases should be reoperated soon after the CSF leak is visible on the dehiscenced wound. The overall mortality rate of 46.4% can be explained since our hospital was located close to the front-line, and some of severely wounded reached our hospital just in time to die. Excluding moribunds and those who died on the operating table (operated immediately after the admission), the mortality was 31.7%.