title: Missile Injuries of Brain - an Experience in Northern Sector.
abstract: During a period of one year, from Jan 99 to Dec 99, 60 cases of missile injuries were treated at our centre. 59 were males and one was a female and their average age was 25 years. 43 patients had suffered splinter injuries, 12 had gunshot wounds and 5 had suffered injuries by improvised explosive devices. Glasgow coma scale was < 5 in 8 patients, 5-8 in 14, 8-12 in 30 and 13-15 in 8 patients. Extensive comminution of skull bones was found in 10 patients. 35 patients had more or less clear penetration of the skull and the rest had orbito-cranial or facio-cranial wounds. CT scan revealed small haemorrhagic contusion with in-driven bones without mass effect in 15, contusion with mass effect in 36 cases, cortical contusions without in driven bones (tangential injuries) in 3, distant intracranial contusions in 4, intraventricular haemorrhages in 5, multilobar injuries in 14, and unilobar injury in 40. 52 patients were operated upon at our centre of which 30 were operated within 24 hours, 10 between 24 to 48 hours, 12 between 48-72 hours. Six patients were treated conservatively and 2 required only simple closure of scalp wound. Craniectomy was done in 10 and craniotomy in 42 patients. Two patients developed wound sepsis, one each developed aspiration pneumonia, septicemia, deep vein thrombosis and post-traumatic hydrocephalus. On follow up at 6 months, outcome as per Glasgow outcome scale was as follows: good outcome - 42, moderate disability in 7, severe disability in 6 and death in 5 patients. Retained bone fragments were found in 40% on follow up CT scan but none had brain abscess.
authors.affiliation: Senior Advisor (Surgery & Neurosurgery), Army Hospital (R&R) Delhi Cantt - 110 010.
authors.forename: Prakash
authors.initials: P
authors.lastname: Singh
authors.affiliation: Dy DGAFMS (P&T), Ministry of Defence, 'M' Block, New Delhi-110 010.
authors.forename: G S
authors.initials: GS
authors.lastname: Misra
authors.affiliation: Senior Advisor (Anaesthesiology), 158 Base Hospital, C/o 99 APO.
authors.forename: Amarjit
authors.initials: A
authors.lastname: Singh
authors.affiliation: Classified Specialist (Radiology), Command Hospital (Northern Command), C/o 56 APO.
authors.forename: Mgk
authors.initials: M
authors.lastname: Murthy
keywords: Brain; Craniotomy; Favourable outcome; Less aggressive surgery; Missile injury