Ulus Travma Acil Cerrahi Derg. 2008; 14(1): 59-64

Craniocerebral civilian gunshot wounds: one hospital’s experience

Aykut Karasu, Tufan Cansever, Pulat Akýn Sabancý, Talat Kýrýþ, Murat Ýmer, Emre Oran, Altay Sencer, Faruk Ünal
Istanbul University, Istanbul Medical Faculty, Neurosurgery Department, Istanbul

BACKGROUND: In this study we have discussed the factors that affect our surgical results according to our experience on patients who were admitted to our hospital’s Emergency Surgery Department for civilian craniocerebral gunshot wounds between 1997 and 2006.
METHODS: The clinical and radiological findings of 82 patients (74 males, 8 females) who were treated for civilian craniocerebral gunshot wounds were retrospectively recorded. Neurological and physical examination, cranial computerized tomography (CCT) findings, trauma types, treatment modalities, prognosis, complications, morbidity and mortality rates were analyzed. RESULTS: Seventy-four (90%) of the patients were male, the mean age was 29.2 year. The Glasgow Coma Scores (GCS) during admission were as following respectively: 3-5 in 35 patients, 6-8 in 9 patients, 9-12 in 19 patients and 13-15 in 19 patients. According to their radiological findings, most commonly subdural hematoma, intracerebral hematoma, multiple contusion, depressed fracture and subarachnoidal hematoma were encountered. Operation or debridement was performed in 51 patients totally. Forty-one patients died and the mortality rate of 82 patients was calculated as 50%. CONCLUSION: The mortality rate of craniocerebral gunshot wound is high. The patients with GCS higher than 8 and with unihemispheric lesions during admission have better prognosis. We concluded that all patients must undergo debridement and the patients that have mass effect must be operated as soon as possible.

Keywords: Debridement, gunshot, mortality; penetrating craniocerebral trauma; surgical treatment.

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Kranyoserebral ateþli silah yaralanmalarý: Bir hastanenin deneyimi

Aykut Karasu, Tufan Cansever, Pulat Akýn Sabancý, Talat Kýrýþ, Murat Ýmer, Emre Oran, Altay Sencer, Faruk Ünal
Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi, Nöroþirürji Anabilim Dalý, Ýstanbul

AMAÇ: Bu çalýþmada, hastanemizin Acil Cerrahi ve Travmatoloji Kliniði’nde 1997-2006 yýllarý arasýnda kranyoserebral ateþli silah yaralanmalarý nedeniyle tedavi edilen sivil olgularda sonuçlarýmýzý belirleyen faktörler saptanarak, klinik deneyimlerimiz doðrultusunda sonuçlar ve cerrahi strateji gözden geçirildi. GEREÇ-YÖNTEM: Ateþli silahla kranyoserebral yaralanma nedeniyle tedavi edilen 82 sivil olguda (74 erkek, 8 kadýn) klinik ve radyolojik bulgular geriye dönük olarak kaydedildi. Nörolojik ve fiziksel incelemeleri, kranyal bilgisayarlý tomografi (KBT) bulgularý, yaralanma þekilleri, tedavi yöntemleri, prognoz, komplikasyon, morbidite ve mortalite oranlarý incelendi. BULGULAR: Hastalarýn 74’ü (%90) erkekti ve yaþ ortalamasý 29,2 idi. Hastaneye kabul sýrasýndaki geliþ nörolojik muayeneleri incelendiðinde Glasgow Koma Skalasý (GKS) deðerlerinin sýrasýyla; hastalarýn 35’inde 3-5, 9’unda 6-8, 19’unda 9-12, 19’unda 13-15 arasýnda olduðu saptandý. Radyolojik inceleme bulgularý sonucunda en sýk, subdural hematom, intraserebral hematom, çoklu kontüzyonlar, çökme kýrýðý, subaraknoidal kanama saptandý. Toplam 51 hastada ameliyat ve debridman yapýldý. Kýrk bir olgu kaybedildi. Toplam mortalite oraný 82 hastada %50 olarak belirlendi. SONUÇ: Ateþli silahla kranyal yaralanma olgularýnda mortalite yüksektir. Hastaneye geliþ muayenelerinde GKS 8’in üzerinde ve tek hemisferi ilgilendiren yaralanmasý olan olgularda prognoz daha iyidir. Tüm hastalarda debridman yapýlmasýnýn, intrakranyal kitle etkisi saptanan hastalarda erken cerrahinin faydalý olduðu sonucuna varýldý.

Anahtar Kelimeler: Ateþli silah, cerrahi tedavi, debridman; mortalite; penetran kranyoserebral yaralanma.

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