Complications of missile craniocerebral injuries during the Croatian Homeland War

Complications of penetrating craniocerebral injuries in war can be early (during the first week after wounding) or late (after that period). Postoperative hematomas, infections, seizures, and cerebrospinal fluid fistulas (CSFFs) are counted among the early complications, whereas foreign bodies migrating intracranially, seizures, infections, and posttraumatic hydrocephalus represent late complications. A total of 176 patients with well-defined head injuries from missiles, sustained during the Croatian Homeland War (1991-1995), developed a total of 61 (34.5%) complications. A retrospective statistical analysis of the medical records of the patients in our series was performed to determine the risk factors for the onset of complications, which have unfavorable effects on outcomes. There were a total of 28 (15.9%) infections (deep or superficial), 21 (11.9%) cases of CSFFs, 9 (5.11%) cases of early epilepsy, and 3 cases of post-traumatic hydrocephalus. A total of 47.6% of patients with CSFFs developed intracranial infections. Of eight patients with meningoencephalitis, five had CSFFs and four had intracranially retained foreign bodies. Only one patient developed a cerebral abscess. Two patients died because of infectious complications (13.3%). Post-traumatic hydrocephalus (1.7%) required shunt placement. For 60% of patients with deep-seated intracranial infectious complications and 76% of patients with CSFFs, reoperations had to be performed, whereas this was the case for only 8% of patients without infections (chi2 = 43.6, p = 0.00001). Intracranially retained foreign bodies, wound age, wound site, and operations performed outside the neurosurgical services were the main risk factors for the development of complications. Complications themselves exerted a very unfavorable influence on outcomes. The development of complications reflects very reliably the neurosurgical technique applied.