On the beginig of the Korean conflict in 1950, we did not have any adequate facilities and systems to treat brain casualties in ROK Army but a neurosurgical team was activated July 1952 by the great help of US Far East Command. US 8th Army and Dr. Meirowsky.
Fortunately the author had a chance to be trained neurosurgery on US hospital.
The author and coworkers treated 1076 cases of head casualties at the newly activated Korean Neurosurgical Team under the unimaginably unfavorable frontline conditions.
I also could find out change of nature of battle through the charactor of injuries and the factors which decreased the mortality compared with that of world war Ⅱ.
Several new conclusions about prognosis and indication of the operation were described.
Study was made by researching 3 major subjects, clinical observation, prognosis of function and life itself and operative indication.
1. Total 1076 head injury cases were hospitalized and treated and from which 12 patients (1,11%) were returned to duty, 17 patients (1,58%) were discharged form hospital, 780 patients (72,39%) were evacuatd and 267 patients (24,80%) had deceased. Within the deceased cases 54 patients (20,22%) were DOAs, 12 patients (4,49%) had deceased among the patients who were operated at other hospitals, 91 patients (34,08%) had deceased without being operated on and 110 patients (10,22%) had deceased after operation.
2. In the cause of injury, 841 cases (78,16%) of SFWs, 90 cases (8,36%) of contusion, 44 cases (4,09%) of GSWs were seen and in the momentum of injury 863 cases (80,20%) of WIA, 98 cases (9,10%) of unknown cause, 66 cases (6,13%) of traffic accident were found. SFWs in action were the most frequent cause of injury.
3. The site of injury was highest in the frontal area with 384 cases (37,14%). Injuries on the left side were seen in 453 cases and on the right side in 368 cases thus over 1.2 times of incidence of the right side was on the left.
4. Majority had taken an average of 12 hours from injury to hospitalization: thus losing so called "Golden Period".
5. A total of 789 cases were operated on. Craniectomy was performed in 643 instances (81,49%), Burr hole in 74 instances (5.95%) and scalp suture in 99 instances (12,54%).
6. As for findings in the operations, 54 cases had frontal sinus involvement which is 6,84% to the total operations, 77 cases of venous sinus injuries (9,75%), 24 instances of intracranial arterial rupture (3,04%), 158 instances of
intracranial venous (20,01%) 574 dural ruptures (72,75%), 77 transventricular wounds (9,75%), 54 cases of falx injuries (6,84%), 1 case of tentorium involvement (0,12%), 14 cases of bounded injuries (1,77%), 891 various hematomas and 13 instances of subdural hydroma (1,64%), were seen.
7. I named "Bounded Injury" for the specific, extensive, and transfalx SFWs and FSWs so as to help for correct decision of operating site.
8. For the purpose of improvement of DOA factors, it should be requested that this team, operating unit and helicopters have to advance forward as much as possible.
9. Major factors of non-operative death are site of injury and degree of injury which cause increasing intracranial pressure and blood loss.
10. post-operative deaths among 789 operations are 110 (13,94%).
11. Among 80 cases of venous sinus rupture 19 cases had deceased post-operatively (23,75%). This high Mortality caused by pressure of hematoma and blood loss.
12. Most of the intracranial arterial hemorrhages are due to the rupture of the middle meningeal artery and its mortality rate was 17,64%.
13. Among the 132 ventricle, falx and tentorium injuries 63 cases (47,72%) expired postoperatively. It is considered as due to extensive injury and midbrain and brainstem injury.
14. I also emphasize strongly that finding out the associated injury, good cooperation with other sections and proper decision of the order of operation in management of associated injury should be done so as to decrease the mortality rate.
15. Post-operative infection rate was much improved compared with that of Europe and America in World War Ⅱ.
16. High mortalities were seen in injuries of falx cerebri, ventricle, artery, vein and bounded.
17. Few cases of functional disturbances were recovered post-operatively (peripheral) but there is no possibility of recover of the damaged central nervous system. Establishmint of the rehabilitation system is eagery required.
18. An operation limit was made, unless certain exceptional condition had to be brought into consideration, on vital signs and blood findings.
That is, body temperature: from 94 degrees to 102 degrees F., systolic blood pressure: 80 to 160mm Hg., pulse pressure: 20 to 80mm Hg., pulse rate: 40 to 120 per minute, Hb contents: more than 10Gm (by Sahli's new type), RBC: over 2,500,000.
19. It is extremely important to check Hb and RBC to find out anemia even in case of normal blood pressure.
20. Operative indication limit described above should be changed and extended.