PENETRATING CRANIOCEREBRAL GUNSHOT WOUNDS

Even though craniocerebral gunshot wounds frequently occur during wars, they are one of seldom causes of civil life head injuries. This study includes the results of diagnosis, treatment and follow-up of 29 civil injury cases, including also detailed literature review. Twenty-five cases had missile injuries, and 8 cases had buck-shots. The Glasgow Coma Scales during admission were between 3-7 in 12 cases, between 8-11 in 11 cases, and between 11-15 in 6 cases. Traumatic subarachnoid hemorrhage was observed in 27 cases (%93), and pneumocephalus in 26 cases (%83). Additionally, 6 cases had intracerebral hematomas, 4 cases large cranial defects, and 2 cases intraventricular hemorrhages. In 19 cases the missile had left the cranial cavity, in 10 cases it stayed inside. Ten cases needed surgical procedure. Only in one case the missile was taken out. But the surgical indication was not the removal of the missile, it was the evacuation of an associated intracerebral hematoma. Later, in two cases abscess formation was observed. The mortality rate of this series is 34 %. The mean follow-up period of survived 19 cases was 26 months, and only two of them have been living without any neurological deficit or sequel. Additionally, the movement of the missile from its initial position was observed in two cases during late follow-up period.

DELÝCÝ KRANYOSEREBRAL ATEÞLÝ SÝLAH YARALANMALARI

Kranyoserebral ateþli silah yaralanmalarý sýklýkla savaþ dönemlerinde görülmekle birlikte, sivil hayatýn da nadir kafa travmasý sebeplerinden biridir. Bu çalýþmada, son dört yýl içinde ateþli silah yaralanmasý sonucu kafa travmasý geçiren 29 sivil yaralanma olgusu taný, tedavi ve takip sonuçlarý ile birlikte literatür gözden geçirilerek özetlendi. Kurþun yaralanmasý 21 olguda, saçma ile yaralanma ise 8 olguda tesbit edildi. Olgularýn kliniðe kabulleri esnasýndaki Glasgow Koma Skalalarý (GKS) 12 olguda 3-7 arasý, 11 olguda 8-11 arasý ve 6 olguda 12-15 arasý idi. Travmatik subaraknoid kanama (SAK) 27 olguda (%93), pnömosefalus 26 olguda (% 83), ayrýca 6 olguda intraserebral hematom, 4 olguda geniþ kranyal defekt ve 2 olguda intraventriküler kanama tabloya eþlik etmekte idi. Ondokuz olguda mermi çekirdeðinin ya da saçmanýn kafayý terk etmiþ olduðu, on olguda ise kranyum içinde kalmýþ olduðu tesbit edildi. Cerrahi giriþim 10 olguya uygulandý. Sadece bir olguda mermi çekirdeði çýkartýldý, ancak bu olguda cerrahi endikasyon kurþunun çýkarýlmasý deðil intraserebral hematomun boþaltýlmasý idi. Ýki olguda geç dönemde abse tesbit edildi. Bu serinin mortalite oraný % 34 olarak tesbit edildi. Hayatta kalan 19 olgunun ortalama takip süresi 26 ay idi ve sadece 2 olgu hiçbir nörolojik defisit veya sekel olmaksýzýn yaþamýný devam ettirmektedir. Ayrýca iki olguda zaman içinde kranyum içindeki kurþunun yer deðiþtirmiþ olduðu tesbit edildi.