CAUSES OF INFECTIONS AND MANAGEMENT RESULTS IN PENETRATING CRANIOCEREBRAL INJURIES

From February 1992 to December 1994, 148 patients with penetrating cra niocerebral injuries were treated surgically with primary and secondar y debridement including repair of dural defects and removal of retaine d intracranial bone and metal fragments. Dural defects were closed pri marily or with temporalis fascia, pericranium, and cadaver graft. Cere brospinal fluid fistulas were observed in 11 (7.3 %) patients: 7 of th ese were infected. Central nervous system (CNS) infection was seen in 2 patients without CSF fistula. Excluding those 11 patients with CSF f istula, CNS infection was shown in 2 of the 137 cases (1.5 %). All pat ients underwent CT scans periodically In 51 (34 %) of 148 patients, bo ne and metal fragments were determined on control CT scans. During thi s time, 12 patients died (8 %). Most of deaths were caused by the dire ct effect of brain injury and occured within the first month after inj ury. Fragments retained after first debridement were followed periodic ally by CT scan. Surgery was not performed until infection developed. Retained fragments did not increase the infection risk, but high rates of infection did occur in cases with CSF fistula.