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Outcome of craniocerebral gunshot injuries in the civilian population. Prognostic factors and treatment options.

Authors
  • Petridis, A K
  • Doukas, A
  • Barth, H
  • Mehdorn, M
Type
Published Article
Journal
Central European neurosurgery
Publication Date
Feb 01, 2011
Volume
72
Issue
1
Pages
5–14
Identifiers
DOI: 10.1055/s-0029-1241850
PMID: 20309801
Source
Medline
License
Unknown

Abstract

Patients with a GCS of 3-8 and two non-reactive pupils should not be operated. If one or both of the pupils are reactive, surgery should be performed irrespective of the GCS score, except in patients with translobar/transventricular wounds. Even if there are no clear contraindications to surgery, the outcome is expected to be poor in patients with a low GCS score, midline shift >10 mm, >2 bone fragments in the brain, and a bilobar, posterior fossa/brainstem or ventricular lesion and ICP >45 mmHg. When surgery is performed the wound and the missile or bone track should be debrided meticulously, the wound and dura should be closed in a watertight fashion and antibiotic prophylaxis as well as tetanus serum should be given.

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