Abstract

Abstract Cranio-cerebral gunshots wounds (CCGW) are the most devastating injuries to the central nervous system, especially made by high velocity bullets, the most devastating, severe and usually fatal type of missile injury to the head. Objective: To investigate and compare, using a retrospective study on five cases the clinical outcomes of CCGW. Predictors of poor outcome were: older age, delayed mode of transportation, low admission CGS score with haemodynamic instability, CT visualization of diffuse brain damage, bihemispheric, multilobar injuries with lateral and midline sagittal planes trajectories made by penetrating high velocity bullets fired from a very close range, brain stem and ventricular injury with intraventricular and/or subarachnoid hemorrhage, mass effect and midline shift, evidence of herniation and/or hematomas, high ICP and/or hypotension, abnormal coagulation states on admission or disseminated intravascular coagulation. Less harmful effects were generated by retained missiles, bone fragments with CNS infection, DAI lesions and neuronal damages associated to cavitation, seizures. Material and methods: 5 patients (4 male and 1 female), age ranged 22-65 years, with CCGW, during the period