Pediatric civilian gunshot wounds of the cranium

Abstract

Pediatric civilian gunshot wounds of the cranium is relatively rare condition in the neurosurgical practice. The medical records of pediatric patients at our Neurosurgery Clinic (Ondokuz Mayis University, Medical Faculty, Department of Neurosurgery) treated for civilian gunshot wounds of the cranium were reviewed to determine the clinical, pathological and radiological features, and the outcome of these lesions. In total, 14 (8 boys and 6 girls) children were cared for between 1990 and 1996. The agressive surgical treatment (urgent craniotomy, meticulous wound debridment and the removal of all accessible bone and bullet fragments, as well as other foreign materials, decompression, and evacuation of the hematoma) were performed all patients exept six patients who in condition of neurological areflexic and respiratuar arrest. 7 (%50) patients died. 3 (21%) patients with no neurological deficite, 2 (14%) patients with hemiplegic, and 2 (14%) patients with persistent vegetative state were discharged. The postoperative complications included scalp wound infection and subcutaneous cerebrospinal fluid leaks (One patient, 7%), intracerebral apse (one patient, 7%), and subdural ampiyem (one patient, 7%). The agressive surgical treatment of the gunshot wounds of the cranium is controversial, particularly the patient was brought deep comatose and unresponsive (areflexic) state. The prognostic factors included that the neurological state on arrival, radiological features, motivation for the shooting, and missile velocity. We have reviewed our experience over a period of 6 years with 14 pediatric patients. Our experience has led us to purpose a agressive operative approach for patients with a Glasgow coma score of 6 to 15 on arrival. The patients having bihemisphere injuries with a Glasgow coma score of 3 to 5 on arrival, and particularly when combined with scattering of bone and metal fragments away from the bullet track, had worse prognose in our series. We believe that operative approach is unnecessary for patients having bihemisphere injuries with a Glasgow Coma Score of 3 to 5 on arrival, exept large defect of the scalp and skull.