Sirko, A.G. and Pilipenko, G.S. and Tonchiev, M.D. (2018) Surgical treatment of combat craniocerebral gunshot wounds combined with paranasal sinuses injury. Вісник проблем біології і медицини=Bulletin of problems biology and medicine, Вип. 4 (том 2). pp. 181-186. ISSN print 2077-4214 online 2523–4110
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Abstract
Abstract. Results of surgical treatment of 30 patients with combat-related gunshot traumatic brain injuries (GTBI) combined with paranasal sinuses injury (PNS) were analyzed. The injuries resulted from local armed conflict in the Eastern Ukraine. Object and methods. The patients were consistently enrolled in the prospective study in the period from May 25, 2014 to December 31, 2017. This group of patients made up 16.3% of all GTBI patients treated during that period. All patients underwent high-resolution cranial CT at admission. Frontal sinus injuries were observed in 25 (83%) cases; ethmoid bone injuries, in 13 (43) cases; sphenoidal sinus injuries, in 1 (3%) case. 26 (87%) patients had penetrating wounds; 4 (13%) patients, non-penetrating cerebral wounds. Fragment mine blast wounds were observed in 26 (87%) cases; 4 (13.3%) wounds were caused by bullets. Blunt wounds were diagnosed in 17 (57%) patients; bound shot wounds, in 7 (23%) patients; penetrating wounds, in 6 (20%) patients. GCS score after initial resuscitation ranged from 5 to 15 (average 10.6±3.5). Four non-penetrating brain wound patients were treated conservatively. Initially, 26 (87%) patients underwent surgery. Emergency intervention was performed to remove intracranial hematoma, close dura mater defects and restore skull base while simultaneously sealing ethmoid and frontal air sinuses. Well-vascularized frontal and lateral pericranial flaps on pedicle in various modifications were used to close frontal sinus and anterior cranial fossa defects. Outcomes. Nasal liquorrhea was observed in 12 (40%) patients at admission and in 2 (7%) patients after treatment. Purulent and septic complications were only detected in 1 (3%) patient. The complications had the form of combined meningoencephalitis, ventriculitis, and subdural empyema. Favourable treatment outcomes (good recovery or moderate disability) in 6 months after treatment were detected in 24 (80%) patients; unfavourable outcomes (severe disability or death), in 6 (20%) patients. Vegetative state was not observed in treated patients. Two lethal cases were not associated with paranasal sinus injury. In one case, there was a severe primary brain injury; in the other case, severe combined internal organ injuries with multiple organ failure.
| Item Type: | Article |
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| Additional Information: | DOI 10.29254/2077-4214-2018-4-2-147-181-186 |
| Uncontrolled Keywords: | бойові вогнепальні поранення, черепно-мозкові поранення, параназальні синуси, назальна лікворея, хірургічне лікування, пластика основи черепа, перикраніальний клапоть, результати лікування, гнійно-септичні ускладнення; боевые огнестрельные ранения, черепно-мозговые ранения, параназальные синусы, назальная ликворея, хирургическое лечение, пластика основания черепа, перикраниальный лоскут, результаты лечения, гнойно-септические осложнения; combat-related gunshot wounds, traumatic brain injuries, paranasal sinuses, nasal liquorrhea, surgical treatment, skull base reconstruction, pericranial flap, treatment outcomes, purulent and septic complications. |
| Subjects: | Neurosurgery |
| Divisions: | Faculty of Postgraduate Education > Department of Neurology and Neurosurgery FPE |
| Depositing User: | Елена Шрамко |
| Date Deposited: | 07 Feb 2019 15:23 |
| Last Modified: | 07 Feb 2019 15:23 |
| URI: | http://repo.dma.dp.ua/id/eprint/3808 |
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