Combat injuries in the midline area of the skull and brain

Background. In modern armed conflicts, gunshot wounds to the head remain a relevant problem. Gunshot midline traumatic brain injury (GMTBI) account for approximately 5 % of all traumatic brain injury (TBI) and characterized by high mortality.

Aim. To determine the anatomical and topographical features of GMTBI, evaluate surgical treatment outcomes, and develop optimal treatment strategy. 

Materials and methods. Single-center retrospective clinical case series was analyzed, including surgical treatment outcomes of 14 patients with GMTBI admitted to City Hospital No. 2, Belgorod, in 2024–2025. All patients underwent clinical and laboratory examinations as well as CT and CT angiography were performed.

Results. Six types of GMTBI were identified based on the location of the entry wound. All patients had fractures of the skull vault and base as well as contusion foci of the brain. Intracerebral hematomas were observed in 77 % of cases. Mortality was 7 %.

Conclusion. GMTBI are a complex group of injuries requiring specialized neurosurgical care. Modern technologies and the refine of surgical techniques can improve treatment outcomes. 

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