Pylypenko H. Surgical treatment of combat penetrating gunshot skull and brain wounds in a specialized medical institution

The thesis discusses the ways to increase efficiency of surgical treatment of victims with combat gunshot penetrating skull and a brain wounds (CGPSBW) in a specialized medical institution, reduce incidence of postoperative complications, and improve neurologic outcomes in wounded patients. The thesis is based on the analysis of results of examination and treatment of 121 victims with combat gunshot penetrating skull and a brain wounds sustained in the armed conflict in Eastern Ukraine. The patients were admitted to the Municipal Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital from May 25, 2014 to December 31, 2017 inclusive. All 121 wounded persons were male aged 18 to 56. Early comprehensive neurosurgical intervention in a specialized medical institution allowed reliable cranial cavity sealing in 97.1% of cases, ensured reliable hemostasis in 93.6% of the wounded, caused regression of axial and lateral dislocation in all operated patients, and allowed reducing repeated surgeries frequency by 52.6%. The clinical efficiency of CGPSBW treatment in a specialized medical institution has been proved. Early comprehensive neurosurgical intervention in CGPSBW based on clinical and computed tomographic wound characteristics is justified. The efficiency of proposed methods of skullbase and basal dura mater defects plasty in craniocerebral injuries combined with paranasal sinuses damage has been proved. A first ever surgical technique for treatment of severe CGPSBW with multifragmental anterior cranial fossa and supraorbital arch fractures accompanied by cerebral edema and intracranial hypertension has been developed and scientifically substantiated. Scientific data on the structure of intracranial purulent and septic complications of modern CGPSBWs, infectious agents, and their sensitivity to antibiotics has been studied and supplemented. Risk factors for purulent and septic complications and their relationship with treatment outcomes have been identified. For the first time, the short- and long-term patient treatment outcomes have been studied and adverse prognostic factors determined, which was used to optimize treatment tactics.