Management of posttraumatic brain swelling based on clinical typing.
OBJECTIVE
To investigate the clinical typing and prophylactico-therapeutic measures for acute posttraumatic brain swelling (BS).


METHODS
A retrospective study was performed in 66 cases of acute posttraumatic BS. There were 3 groups based on computered tomography (CT) scanning: 23 cases of hemisphere brain swelling (HBS) with middle line shift for less than 5 mm within 24 hours (Group A), 20 with middle line shift for more than 5 mm (Group B), and 23 with bilateral diffuse brain swelling (Group C).


RESULTS
(1) The mortality rates of the operative and nonoperative management in Group A, Group B, and Group C were 20.0%, 31.6%, and 75.0% versus 44.4%, 0, and 85.7%, respectively (P>0.05); while the rates in subgroups with different middle line shift (more than 5 mm and less or equal 5 mm) were 29.2% and 75.0% versus 75.0% and 44.4%, respectively (0.05>P>0.01). (2) The good recovery rate and mortality in Group A were 47.8% and 39.1%, respectively and in Group C, 8.7% and 78.3%, respectively. There was a very significant difference between Group A and Group C (P<0.01). (3) The total survival rate of the selective comprehensive therapy was 53.1%.


CONCLUSIONS
(1) Acute posttraumatic BS needs to be diagnosed correctly and promptly with CT scanning within 4 hours. (2) For patients with midline shift for more than 5 mm, especially with thin-layered subdural hematoma, surgical intervention is essential to reduce the fatality of acute posttraumatic BS.
Department of Neurosurgery, The Second Hospital Affliated to Zhejiang University, School of Medicine, Hangzhou 310009, China.
Wei-guo
WG
Liu
Wu-si
WS
Qiu
Hong
H
Shen
Wei-min
WM
Wang
D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000628:therapy*; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies