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This was a prospective study that aimed to analyze the efficacy of conservative management in patients with shrapnel injuries (SI) due to bomb blasts.Patients with SI to the brain due to bomb blasts during the study period were enrolled in the study. After initial resuscitation, the patients were divided into 2 groups. Group 1 was the one in which patients were managed by supportive care with or without simple wound closure. In group 2, all patients were managed operatively (OM) provided they met the inclusion criteria.In the study group, 61 patients with SI due to bomb blasts were enrolled. Out of 61 patients, 46 (75.4%) had favorable outcome and 15 (24.6%) had unfavorable outcome. Of the 45 patients in conservatively managed group, 37 (82.2%) had a favorable outcome whereas 8 (17.8%) had an unfavorable outcome. In the OM group, 9 (56.3%) had a favorable and 7 (43.8%) had an unfavorable outcome. This was mostly because of poor neurologic status of the patients in the OM group. However, the 2 groups did not have a significant difference in postoperative incidence of infections and seizures.This study is not intended to minimize the importance of surgical management of penetrating missile injuries to the head. Such treatment is most often necessary in cases with definite indications. Conservative management (supportive care) alone or along with simple wound closure is equally effective and has now become an important choice for neurosurgeons facing a large number of casualties, particularly in developing countries.