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.