Intracranial pressure monitoring for special patterns of frontal lobe contusions.
OBJECTIVE
To study the effect and indications of intracranial pressure (ICP) monitoring for frontal lobe contusion patients.


METHODS
During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department (monitoring group). Different treatment protocols were adopted according to the results of ICP. Meanwhile 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group.


RESULTS
We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases (70.6%) , moderate disability in 7 cases (20.6%), severe disability in 2 (5.88%) and death in 1 (2.94%). The outcome of control group displayed good condition in 25 cases (54.3%), moderate disabilities in 8 (17.4%), severe disability in 7 (15.2%), and death in 6 (13.0%).


CONCLUSIONS
Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. If ICP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.
Dong
Ji-rong
JR
Neurosurgical Department of 101 Hospital of PLA, Rescue Center of Craniocerebral Injuries in Army, Wuxi, China. jirong1966@sina.com
Cai
Xue-jian
XJ
Wang
Biao
B
Wang
Yu-hai
YH
Shi
Zhong-hua
ZH
Liu
Bing
B
Cai
Sang
S
Xu
Qin-yi
QY
D000293:Adolescent; D000328:Adult; D000368:Aged; D003288:Contusions / Q000503:physiopathology*; D006259:Craniocerebral Trauma / Q000503:physiopathology*; D005260:Female; D005625:Frontal Lobe / Q000293:injuries*; D015600:Glasgow Coma Scale; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged