Treatment of war-related penetrating brain injury during Syrian conflict : importance of debridement and meticulous closure

Abstract EN

Background : Principles of treating war-related penetrating brain injury had been developed long time ago.

Some neurosurgeons advocate the traditional surgical repair with thorough debride-ment and tight closure especially the dura.

Other minimalists prefer simple wound closure.

Aim: Presentation of 28 patients with penetrating brain injury who had been surgically treated during Syrian conflict.

The author reviews related literature and compares between minimal and tradi-tional approaches.

Methods: A descriptive study of 28 patients who had been operated in North Syria during March-April 2013.

Operative technique included thorough debridement, removal of accessible in-driven bone fragments and foreign bodies, hemostasis, water-tight repair of the du-ra and scalp closure.

Karnofsky score and Glasgow Outcome scale were used for outcome as-sessment.

Results: We performed 30 operations for 28 patients (24 males / 4 females).

Age was 22 ± 15 years (range 3-55).

At admission, Glasgow Coma Score of 15-13 was (35.7 %), 12-9 was (21.4 %), and 8-3 was (42.9 %).

Outcome evaluation after 1 month showed good recovery in (39.3 %), moder-ate recovery in (21.4 %), severe disability in (28.6%), vegetative status in (3.6 %), and death of 2 (7.1 %).

Complications were very minor (10.7 % superficial infection).

Two patients needed reoperation; 1 for bullet removal and the other for evacuation of collected hematoma.

Conclusion: Minimal brain debridement is more likely to require an additional debridement and may results in higher inci-dence of life-threatening CSF leak or fatal meningitis.

Adequate debridement, removal of bone chips, foreign bodies, and tight closure of the dura should be performed in penetrating brain inju-ry.