The surgical management of severe open brain injuries with consideration of the long-term results.

Twenty-three patients, ranging in age from 4 months to 80 years, who suffered open brain injury with loss of at least 4 cm2 of cerebral cortex, and who underwent surgery, have been followed until their death or from periods ranging from 3 to 16 years. Gunshot wounds and open or depressed fractures with smaller lacerations of the brain were not included. The principles of surgical management important for the preservation of life and the retention of maximum brain function have been employed: debridement of all necrotic tissue after thorough irrigation and cleansing, then reconstitution of all tissue layers as completely as possible. The causes of death in three patients as well as of complicating factors in the 20 survivors, such as organic dementia, post-traumatic psychosis, paralysis, cerebral sensory loss, and epilepsy, are reviewed.