Gunshot Diametrical Craniocerebral Wounds

Lebedev V., Zharikova .

Sklifosovsky Research Institute of Emergency Care, Moscow, Russia


Introduction. During WWII the rate of diametrical craniocerebral wounds (DCCW) was 3.9%. In peace-time this index is as high as 12.3%. The mortality rate is 98-100%.

The research goal was to determine causes of death and to find ways of its reduction.

Material and Methods. There were 203 cases with gunshot craniocerebral wounds (GCCW); they were diametrical in 12 of them (5.9%). The mean age was 39 years.

Results and Discussion. As for the wounded with DCCW, 11 out of 12 cases died. One patient was discharged in a satisfactory state; 4 wounded were not operated because of an extremely severe condition. They died during a period of time, varying from 2 hours up to 2 days. Operations were performed 6-12 hours after wounding in 8 cases; 4 wounded died during the first hours after operation. Death occurred on the 3rd-4th day in 2 cases. All these wounded had multiple injuries of the brain and cracking of the skull. There were two cases, who died of pneumonia and meningitis on the 10th and 26th day respectively.

Conclusion. Gunshot DCCW are not absolutely fatal. Bleeding is the only indication for urgent operation. It can be postponed for carrying out resuscitative procedures and performed 6-8 hours later. Debridement of a wound canal should be careful and at the same time sparing for the brain substance. A bullet removal is desirable, but it should not be idee fixe. Early surgical intervention and intensive therapy can save lives of 8-16% of such cases.