title: Syria civil war: Outcomes of humanitarian neurosurgical care provided to Syrian wounded refugees in Israel.
abstract: BACKGROUND
  As an expected consequence of the civil war in Syria, emergent neurosurgical care for battlefield trauma has been provided for severely head-injured Syrians transferred to Northern Israel.
  
  
  METHODS
  Sixty-six patients suffering from brain injury were brought to the border and then referred to the institution after initial resuscitation. Both the time and type of injury were recorded based on paramedic testimony, forensic material or on details provided by patients. A retrospective analysis of all medical charts and imaging material was performed.
  
  
  RESULTS
  Most injuries were combat-related, either caused by blast (13.6%), shrapnel (24.2%), assault (28.8%) or gunshot wound (15.2%). Only a minority of patients (18.2%) suffered from injuries that were not directly caused by weapon. A total of 55 surgical procedures were performed in 46 out of 66 patients, including craniotomies in 40 patients, burr hole alone for placement of intraparenchymal intracranial pressure (ICP) sensor in nine instances and ventricle peritoneal shunt in two patients. Decompressive craniectomy was used only for the treatment of gunshot wound and was performed in eight out of 10 patients. The most common complication consisted in cerebrospinal fluid fistulas (16.7%). Post-operative infections occurred in seven patients (10.6%). Short-term outcomes were favourable in 60.7%, with a mortality rate of 4.5%.
  
  
  CONCLUSIONS
  The present findings suggest that aggressive surgery and neuro-intensive care measures may lead to good functional results, even in the presence of seemingly devastating injuries in some selected patients.
authors.affiliation: a Faculty of Medicine , Bar Ilan University , Safed , Israel .|b General Direction , and.
authors.forename: Masad
authors.initials: M
authors.lastname: Barhoum
authors.affiliation: c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel.
authors.forename: Samuel
authors.initials: S
authors.lastname: Tobias
authors.affiliation: c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Elron
authors.affiliation: c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel.
authors.forename: Aviram
authors.initials: A
authors.lastname: Sharon
authors.affiliation: c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel.
authors.forename: Tariq
authors.initials: T
authors.lastname: Heija
authors.affiliation: a Faculty of Medicine , Bar Ilan University , Safed , Israel .|c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel.
authors.forename: Jean F
authors.initials: JF
authors.lastname: Soustiel
mesh_terms: D000328:Adult; D000533:Altruism; D001930:Brain Injuries / Q000209:etiology / Q000601:surgery*; D056424:Decompressive Craniectomy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012036:Refugees; D012189:Retrospective Studies; D013593:Syria; D016896:Treatment Outcome; D014857:Warfare; D014948:Wounds, Gunshot / Q000209:etiology / Q000601:surgery; D055815:Young Adult
keywords: Brain injury; gunshot wound; neurotrauma; penetrating brain injury; war