title: Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war.
abstract: OBJECTIVE
  Toward the end of 2010, the Arab spring, the waves of revolutionary demonstrations and protests influenced also Syria, where violent clashes turned into a civil war. Hundreds of thousands of people became refugees. The use of excessive force unfortunately culminated in numerous deaths and injuries in many cities. Being the closest city to Aleppo, Damascus and Homs, the biggest cities of Syria, Antioch/Hatay has been the city where initial emergency treatments were performed. For this reason, we examined and retrospectively analyzed the medical records of the patients treated in the clinics of our hospital due to cranial gunshot wounds during the war.
  
  
  METHODS
  The medical records of 186 patients who were injured in the Syrian War and brought to, followed up and treated in the Neurosurgery Clinic of Mustafa Kemal University, Faculty of Medicine in Hatay, a Turkish city on the Syrian border, between April 2011 and June 2013.
  
  
  RESULTS
  A total of 186 patients were evaluated in a period of more than 2 years. Of all 91.4% of the patients were adults (male/female: 152/18) and 8.6% of them were pediatric patients (male/female: 14/2). The average age of the patients was 31 years, with an age range of between 2 months and 67 years. According to Glasgow coma score (GCS) of the patients at the time of admission, GCS was 3 in 32 patients (17.2%), between 4 and 7 in 70 patients (37.6%), and between 8 and 15 in 84 patients (45.1%). We observed that the patients with GCS of 4-7 had a significantly lower mortality among the 56 patients treated surgically compared with the 14 patients treated medically.
  
  
  CONCLUSIONS
  Cranial gunshot wounds are responsible for high mortality and morbidity. A multiplicity of factors plays a role on morbidity and mortality. These are the duration of transport, the injury pattern, the velocities of the weapons used, and the Glasgow Coma Scales of the patients at the time of admission.
  
  
  CONCLUSIONS
  The authors recommend that the patients with cranial gunshot wounds who has GCS of 4-7 should be aggressively treated including surgery as well. We do not recommend surgical treatment for patients with GCS of 3. All our experiences show that treatment of gunshot wounds will continue to be a matter of debate, about which there is more to learn. The data presented in this study will once again demonstrate the seriousness of the event, and will, perhaps, contribute to the peace negotiations to end the war.
authors.affiliation: Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey. Electronic address: maras.70@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Aras
authors.affiliation: Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Altaş
authors.affiliation: Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Yilmaz
authors.affiliation: Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Serarslan
authors.affiliation: Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
authors.forename: N
authors.initials: N
authors.lastname: Yilmaz
authors.affiliation: Department of Family Medicine, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Yengil
authors.affiliation: Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Urfali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D020197:Head Injuries, Penetrating / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012886:Skull / Q000473:pathology*; D013593:Syria; D014857:Warfare; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Brain; Brain injury; Cranial gunshot wounds; Syria