Retained intracranial splinters : a follow up study in survivors of low intensity military conflicts.

With improvements in the ballistic physics, patient evacuation, imaging, neurosurgical management and intensive care facilities, there has been overall improvement in the survival of patients with missile injuries of the brain. Patients with retained intracranial fragments have been followed up and the sequelae of such fragments were analysed. We present our observations in 43 such patients who had survived low velocity missile injuries of the brain during military conflicts and had retained intracranial fragments. Over a follow up period of 2 to 7 years, suppurative sequelae (brain abscess, recurrent meningitis) were seen in 6 patients, two of these progressing to formation of brain abscess. Three patients developed hydrocephalus and one seizures. Patients with orbitocranial or faciocranial wound of entry had a higher incidence of suppurative complications (3 out of 4), while those with skull vault entry had a lower incidence of such sequelae (7 out of 30). Nine patients were lost to follow up. Other determinants of suppurative complications were postoperative CSF leak and intraventricular lodgement of the fragment.