CIVILIAN CRANIOCEREBRAL GUNSHOT WOUNDS IN BASRAH

Background Gunshot wounds are most common penetrating head injuries in the civilian setting in Iraq. Although, they are highly lethal and some patients need urgent neurosurgical care, the majority of them carry good prognosis. Aim To determine factors, which affect the outcome of patients with craniocerebral gunshot injury. Patients and Method A prospective study on 144 surgically treated gunshot penetrating head injured patients in Alsedir Teaching Hospital between June 2007 ? June 2011 was carried out. After resuscitation a neurological examination was done and the injured patients were classified according to severity using Glasgow Coma Scale (GCS) into mild injury (score 13-15), Moderate injury (score 9-12) and Severe injury (score 8 -6). CT scans were performed on all patients to determine intracranial lesions. Results 112 of the patients were males and 32 females. Forty-four percent of patients’ age was between 16-30 years. The most frequent site of the bullet entrance was on right side in 112 patients. Neurological signs include 24 patients had motor weakness, and 8 patients had dilated pupil. CT findings include 24 patients had ICH, 24 patients had SDH, 16 patients had IVH and 116 patients had less than 3 injured lobes. Accidental injury occurred in100 patients. Postoperative complications are stitch abscess in 16 patients, hydrocephaly in 8 patients and cerebrospinal fluid fistula in 8 patients. Hundred patients had good outcome while 20 patients died within 48 hours postoperatively. Conclusions Factors seem to be associated with prognoses are GCS, the site of bullet entrance, some CT findings, dilated pupil, and the underlying events.