Armed Conflict has always provided the surgeon with an opportunity to advance the science of trauma surgery. In the words of Hippocrates, “let him who wishes to be a surgeon go to war.” Ambrose Pare further reiterated, “in the pursuit of his profession, a surgeon can wish no more welcome test of fire than the battlefield.” However, with growing specialization, surgery for missile injuries in general is frequently viewed as a backwater experience, and appears to be peripherally related to the mainstream neurosurgical training and practice in most of the institutions. It should however be remembered that violence has become a public emergency, growing steadily in spite of methods thus far used in its control. Following figures will bear out the lethality of gunshot wounds:
Compared to the missile wounds of the chest which carry 48 to 77% mortality, 75 to 80% of craniocerebral missile injuries (CMIs) are fatal (Awasthi et al 1992). Most of the patients do not survive to be seen by the neurosurgeon. According to Kaufman et al (1996), 90% of the patients die, two-thirds at the scene of injury. Survivors with CMI constitute less than 10% of the head injured patients who survive (Grafman and Salazar 1987). Siccardi et al (1992) in a prospective study of 314 patients found that 73% died at the scene, another 12% died within three hours of injury, and an additional 12% died later, with a total mortality of 92%. Similarly, data from Traumatic Coma Data Bank reveals a mortality of 88% in this population (Eisenberg et al 1990).
It is doubtful whether any other neurosurgical pathology can boast of such morbid figures.
- Awasthi D, Hickey J, Carey ME. Civilian gunshot wounds to the head. A demographic study. Paper presented at the 60th. Annual meeting, AANS, San Fransisco, 1992.
- Eisenberg HM, Gary HE Jr, Aldrich EF, et al: Initial CT findings in 753 patients with severe head injury. A report from NIH Traumatic Coma Data Bank. J Neurosurg 1990; 73: 688-98.
- Grafman J, Salazar A. Methodological considerations relevant to the comparison of recovery from penetrating and closed head injuries. In, Levin HS, Grafman J, Eisenberg HM (Eds). Neurobehavioural recovery from head injury. Oxford University Press; 1987; 43-54.
- Siccardi D, Cavaliere R, Pau A, et al: Penetrating craniocerebral missile injuries in civilians. A retrospective analysis of 314 cases. Surg Neurol 1991; 35: 455-60.