Modern Military Neurotrauma and its Complications in War Conditions in megalopolis

Over the period from May 2014 to the present in the neurosurgery clinic more than 4000 people with closed and open (penetrating) head injuries (which were received during the military actions) was given appropriate neurosurgical care. Patients were examined with CT, MRI, radiography of the skull bones [1]. The patients were examined by traumatologists, ENT specialists, oculists, maxillofacial surgeons, combustiologists, neuroreanimatologists. Time from injury to operation is up to 2 hours (Figure 18,19,20,21 and 22). The military actions are taking place in a megapolis (in a city with a population of 1 million inhabitants). The distance from the closest flashpoint till the neurosurgical clinic is approximately 13 km (Figure 23, 24 and 25). The patients underwent neurosurgical operations - primary surgical treatment (PST) of gunshot wounds of the skull with the removal of hematomas, bone fragments and shell fragments, plastic of bone defects, skull surfaces [2].

Wounds of soft tissues of the skull are up to 2000 people . Nonpenetrating wounds of the skull bones are up to 1200 people. Penetrating craniocerebral injuries are up to 800 people [3 - 6]. • Prognosis of life of patient damaged with projectile is higher, in comparison with damaged with bullet because of low kinetic force of projectile. • By bullet wounds are taking place more tissue damages due-to higher kinetic force of bullet. . Primary surgical treatment (PST) is performed outside the specialized center only because of vital indications to non-transportable patients. Transportable patients should be transported as quicker as possible in a specialized neurosurgical center in order to reduce the liquorrhea, tissue, vascular and Wounds of soft tissues of the skull are up to 2000 people . Nonpenetrating wounds of the skull bones are up to 1200 people. Penetrating craniocerebral injuries are up to 800 people [3 - 6]. 5. Conclusion By modern military actions in a megalopolis conditions more than 50% of the injured are injured in the head. In military operations in addition to soldiers among the victims are a large number of civilians - up to 25%. During military actions in the megalopolis, the first medical aid was provided by ambulance teams, which delivered patientsto the clinic of neurosurgery. The military first medical aid was given on the battlefield [6]. These patients were delivered by passing transport. Time from getting the wound to providing specialized neurosurgical care to all patients is up to 2 hours. In connection with this the number of pyoinflammatory complications after treatment of patients with gunshot wounds to the skull is relative small - up to 1%. Died patients were in up to 20% of cases had combined wounds of the limbs, chest, abdomen, head. So we determined that: • The average time from admission of a patient till getting professional neurosurgical care should be not more than 2 hours. • The number of pyoinflammatory infections by projectile wounds of the skull directly depend on the speed of receiving professional neurosurgical treatment. • The projectiles with depth localization are not recommended to remove. pyoinflammatory complications.

References 1. Okie S. Traumatic brain injury in war zone/ S.Okie//New Engl.J.Med.- 2005; Vol. 352: N20 P. 2043 - 47. 2. B.V.Gaidar, U.A.Shulev, U.V.Dikarev// Battle injuries of skull and brain/ Practical neurosurgery: guidelines for doctors under red. B.V.Gaidar – СПб.:Гиппократ, 2002; P.112 - 136. 3. Gean A.D. Brain injury: applications from war and terrorism/ Philadelphia: Lippincott Williams & Wilkins, 2014; -338p. 4. Beseri, ND, Santel J, Jelavic Koic. CT analysis of missile head injury// Neuroradiology. 1995; Vol.37 N3: P. 207 - 211. 5. Clinical practice guidelines. Joint theater trauma system: practical emergency information for critical trauma care from military experts/ United States Army, Depertment of Defense, Medical Research and Material Command, United States Military, United States Army Institute of Surgical Research - 2012. 6. A.N.Konovalov, L.B.Lichtermann, AA.Potapov. Clinical guidelines of traumatic brain injury under red – Chapter 21. Battle injuries of skull and brain. M. Антидор, 2001 – P. 451 - 474

Lystratenko OI. Modern Military Neurotrauma and its Complications in War Conditions in megalopolis . Annals of Clinical and Medical Case Reports 2019