Penetrating orbitocranial gunshot injuries.
BACKGROUND
The aim of this study was to analyze the effect of a surgical management protocol and other important clinical features on the prognosis of patients who had penetrating orbitocranial gunshot injuries.


METHODS
Thirty-five patients (30 unilateral, 5 bilateral) who had penetrating orbitocranial gunshot injuries were analyzed. The wounds were mainly caused by shrapnel fragments or bullets. Craniotomy was the standard treatment in all patients. Investigated clinical features included Glasgow Coma Scale (GCS) score on admission, the mode and the extent of brain injury, and the presence of an intracranial retained foreign body. The prognostic importance of complications such as infection, intracranial hemorrhage, cerebrospinal fluid leak, and epileptic seizures was also investigated. The mechanism and the injury characteristics of the patients were evaluated by predicting the visual outcome of the victims according to a newer classification system as well as other variables pertinent to this specific clinical setting of severe eye trauma. Final visual acuities of the patients were also measured.


RESULTS
The outcome of 35 penetrating orbitocranial gunshot injured patients was as follows: death in 3 patients, vegetative state in 1, severe disability in 2, moderate disability in 2, and good recovery in 27 cases. Localization and extent of the injury and GCS score on admission were the most important indicator for good neurological outcome. The predictors for good visual outcome were type B, grade 1, zone I, and relative afferent pupillary defect-negative injuries. The predictors for poor outcome were type A, grade 5, zone III, and relative afferent pupillary defect-positive injuries.


CONCLUSIONS
The prognosis of the injury depends on the course of the bullet or shrapnel fragment and the interdisciplinary care. An extensive preoperative evaluation of penetrating orbital trauma and a combined ophthalmic and neurosurgical approach are recommended to minimize the morbidity of the patients. However, complete removal of the foreign material in a deep or ventricular localization is not mandatory because careful debridement and tight closure of dura provides desired outcome. Evaluation of trauma mechanism and injury characteristics according to the Ocular Trauma Classification System seems to predict accurately the visual outcomes in this series.
Gönül
Engin
E
Department of Neurosurgery, Gülhane Military Medical School, 06018 Ankara, Turkey. egonul@gata.edu.tr
Erdoğan
Ersin
E
Taşar
Mustafa
M
Yetişer
Sertaç
S
Akay
K Melih
KM
Düz
Bülent
B
Bedük
Altay
A
Timurkaynak
Erdener
E
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000503:physiopathology; D001766:Blindness / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D003399:Craniotomy / Q000379:methods; D004827:Epilepsy / Q000209:etiology / Q000503:physiopathology; D015807:Eye Injuries, Penetrating / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D013353:Subdural Effusion / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*
D000900:Anti-Bacterial Agents