PENETRATING CRANIOCEREBRAL SHRAPNEL INJURIES DURING OPERATION DESERT-STORM - EARLY RESULTS OF A CONSERVATIVE SURGICAL-TREATMENT

A follow-up study is presented of the initial neurosurgical treatment of 20 patients who sustained penetrating craniocerebral injuries durin g ''Operation Desert Storm''. Fifteen of these patients had received i ntracranial debridement through a craniectomy and five patients had re ceived care of scalp wounds only. Following treatment and stabilisatio n in a frontline hospital, these patients were transferred to the Riya dh Armed Forces Hospital for further evaluation and management. On adm ission, all the patients received a computerised tomographic scan whic h revealed shrapnel fragments inside their brain. No attempt had been made to remove the metal fragments. A patient with an infected scalp w ound was treated with a course of appropriate antibiotics and the woun d dressed. Dexamethasone was not used. Anticonvulsants were used only in one patient who had been treated for a presumed cerebral abscess. T he neurological status of the patients improved along with the reducti on of oedema and the swelling of the brain as shown in the follow-up C T scans. No patient died or developed a seizure disorder. These result s suggest that re-operation for removal of retained fragments is unnec essary. It is concluded that the initial treatment of shrapnel wounds of the brain should be to preserve maximal cerebral tissue and functio n either by limiting the wound debridement performed through a craniec tomy or by care of scalp wounds only.