[Craniocerebral gunshot wounds in civilian population: Analysis of experience in a single center in Monterrey, México].

BACKGROUND Gunshot wounds in civilian population of México were quite rare. Currently, conflicts amongst organized crime groups are carried out with weapons, which are considered as exclusive use by the natiońs army. OBJECTIVES Describe the experience of our institution and share results of clinical and radiological factors influencing the prognosis of the patients. MATERIAL AND METHODS Observational and retrospective study of patients with cranial gunshot wounds (GSW), which penetrated the duramater, treated from January 2009 - January 2013. We considered several demographic variables, Glasgow Coma Scale (GCS), upon admission, state of pupils, type of surgery and size of decompression, Glasgow Outcome Score (GOS) upon discharge, and after 6 months. RESULTS Of 68 patients, we excluded those whose duramater was not penetrated, leaving 52 patients. The average age was 28.7 years, and 80.8% were males. All were surgically intervened, with 8% of general mortality. Mortality in the GCS 3 to 5 points group was 43%, from the 6 to 8 points it was 6%, and no deaths in the 9 to 15 points. In patients with both pupils fixed, anisocoric and isocoric, mortality was 67%, 7%, and 3%, respectively. Bihemispheric, multilobar and unihemispheric trajectory of the bullet plus ventricular compromise was related to a Glasgow Outcome Score ≤ 3 upon discharge in 90.9% of the cases. CONCLUSIONS GCS upon admission and state of the pupils are the most influential factors in the prognosis. Patients with a GCS > 8 < 13 points upon admission, normal pupillary response, without ventricular compromise can benefit with early and aggressive surgical treatment.