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The Management of .22 Caliber Gunshot Wounds of the Brain: A Review of 49 Cases

Published online by Cambridge University Press:  18 September 2015

L. Suddaby ,
B. Weir  and
C. Forsyth
L. Suddaby*
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
B. Weir
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
C. Forsyth
Affiliation:
Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
*
Department of Surgery, 2D2.24 W.C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2B7
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Abstract:

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We analyzed the charts and CT scans of 49 cases of civilian .22 caliber gunshot wounds of the brain admitted to the University of Alberta and Royal Alexandra Hospitals between 1975 and 1985. The average age of the patients was 30 years, 88% were males, 88% were suicide attempts. There were no deaths among patients with an initial coma score above 12 whereas the mortality rate was 85% for those admitted with a score of 7 or less. All those with fixed pupils on admission died. The overall mortality rate of 61% is comparable to that of other series of civilian gunshot wounds including those in which more aggressive surgical management was undertaken. We recommend that no treatment be given those cases with an admission coma score of 3 and/or fixed pupils and that simple scalp wound debridement be employed with those having a coma score of 7 or less. Tract exploration and retrieval of bullet fragments is not indicated, as retained fragments carry a very low incidence of complications (e.g. abscess formation). In patients in good condition (GCS ≥ 12) the management of intracranial hematomas should be independent of their etiology and approached aggressively.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 14 , Issue 3 , August 1987 , pp. 268 - 272
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

References

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