Early complications following penetrating wounds of the brain

The experience of an evacuation hospital in Japan in treating 506 consecutive patients from Vietnam with penetrating wounds of the brain is reported with particular reference to early complications. Sixty-eight patients were operated on for still retained intracranial foreign bodies. Thirty-five of the 62 patients with retained intracranial bone fragments had positive microbial cultures of the fragment, which in 63% showed Staphylococcus epidermis. All of the metallic fragments cultured revealed microbial growth. Superficial infections were noted in 32 patients. Superficial plus deep infections were found in eight patients with no retained bone fragments. Eighteen patients had meningitis proven by culture, while an additional 12 patients with CSF sugars of less than 40 mg% were assumed to have meningitis. Twelve patients developed CSF leaks requiring surgery. Twenty-three patients (4.54%) died as a result of their wounds. The neurosurgical treatment recommended for these patients is described.