Early surgery and other indicators influencing the outcome of war missile skull base injuries.

BACKGROUND: The aim of this study was to analyze the effect of early surgical management protocol and other important clinical features on the prognosis of patients suffering from war missile skull base injuries. METHODS: Twenty-one patients who suffered from war missile skull base injuries were analyzed in this study. The wounds were mainly caused by shells and/or bullets. Craniotomy represented the standard treatment in all patients. Investigated clinical features included Glasgow Coma Scale score on admission, the mode and the extent of brain injury, time to patient admission to hospital, and the presence of an intracranially retained foreign body. The prognostic importance of complications such as infection, intracranial hemorrhage, cerebrospinal fluid leak, and epileptic seizures was also investigated. RESULTS: The outcome of 21 skull base injuries was as follows: death in seven patients, vegetative state in three, severe disability in two, moderate disability in seven, and good recovery in two patients. The clinical characteristics that implied favorable outcome were: Glasgow Coma Scale score greater than 12, location of injury in the anterior cranial fossa, time to admission shorter than 1 hour, and absence of an intracranially retained foreign body and postoperative complications. The statistical significance of those predictors was at the level of p < 0.001 in all cases. CONCLUSIONS: Although the wounds were associated with a high mortality rate, this study showed that there are major differences in prognosis of patients with war missile skull base injuries with respect to certain presenting clinical features.

[Use of intraoperative ultrasound in neurosurgery]. / Uporaba intraoperacijskog ultrazvuka u neurokirurgiji.

Intraoperative ultrasound (US) is a device which is a great help to neurosurgeon in intracerebral lesions localization, in the definition of inner tumors structure, in its relation to the surrounding structures, as well as during stereotaxic operations. We report our experiences with US in more than 500 operations. Its maximum usage is during gliomas and metastases operations because of their subcortical localization. Choosing this optimal approach to the tumor, the surrounding brain is minimally damaged. Using modern devices we are able to distinguish edema from infiltrative gliomas, which was not possible using former devices (both edema and gliomas are hyperechoic). In vascular neurosurgery we use US mostly in the localization of small arteriovenous malformations (AVMs). In pediatric neurosurgery the usage is very often in drainage operations for ventricular catheter placement control. The main US shortage is lower image resolution, and the basic advantage is real time imaging. It enables our prompt intervention in every unfavorable situation.

Spinal stability after war missile injuries of the spine.

OBJECTIVE: Spinal stability after surgery for war missile wound to the spine is addressed in this study. DESIGNS: A retrospective 4-year analysis of 21 patients. MATERIAL AND METHODS: The most common injuries were of the thoracic and lumbar spine. The injuries were frequently associated with the lesions of other organs. We registered extensive initial neurologic deficit in 47.6% of cases. All the patients were treated surgically. MEASUREMENTS AND MAIN RESULTS: A decompressive laminectomy was performed in 80.9% of cases. Internal stabilization after laminectomy was performed in only one patient in our series. None had clinical signs of instability. There were no radiologic signs of postoperative spinal instability found on mean follow-ups of 15 months. CONCLUSIONS: Wound debridement with or without removal of bony and foreign body fragments from the spinal canal was performed. A laminectomy is considered a method of choice. The spine was not stabilized in most patients because the facet joints were left intact.

Analysis of projectile destructive effect in missile injury to the brain.

During the war in Croatia so far, more than 250 casualties having missile wounds of the brain, spinal chord and peripheral nervous system were admitted to the Neurosurgical Clinic, University Hospital-Rebro. These injuries were mainly caused by low-velocity missiles. However, the high-velocity ones, used nowadays, in direct injury to the head, cause destruction of the brain that is incompatible with survival in most of the cases. This paper deals with a patient injured by a 7.62 mm projectile. The mechanism of the brain destruction is not completely clear since the missile was found at the very entrance of the missile wound, while the brain was destroyed up to the opposite side of the endocranium. Four mechanisms of the missile's effect aimed at explaining the cause of death of the patient, as well as the bizarre position of the missile, were taken into consideration. The review shows how perilous a wound from a direct missile injury to the head could be, regardless of its speed.

[Current diagnosis and treatment of intracerebral abscess]. / Suvremena dijagnostika i lijecenje intracerebralnog apscesa.

Experiences in the diagnosis and treatment of an intracerebral abscess with the aid of computed tomography of the brain (superior to all past diagnostic procedures) have been presented; 28 patients were elaborated and some of them more extensively described, especially those of particular interest due to the abscess' localization and its differential diagnosis.