title: The diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions.
abstract: The objective of this study was to investigate the diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. A total of 63 patients (45 men and 18 women; mean age of 43 years with a range from 20 to 72 years) who suffered from traumatic bifrontal contusions between January 2007 and December 2012 were inspected. The clinical and imaging results were studied for all patients, and we found that swelling of the mesencephalon and a downward shift of the bilateral red nucleus were significant signs of central brain herniation in the image of magnetic resonance imaging. All patients were given a simultaneous bilateral craniotomy for balanced decompressive surgery. The Glasgow Outcome Scale was used to monitor the patients during the follow-up period, which lasted from 6 to 52 months with a mean of 22 months. At the termination of the follow-up period, the following Glasgow Outcome Scale scores were obtained: 14 patients scored 5 points, 22 patients scored 4 points, 7 patients scored 3 points, 13 patients scored 2 points, and 7 patients scored 1 point. Therefore, our study suggested that an early magnetic resonance imaging scan could result in a more timely diagnosis of central brain herniation, and simultaneous bilateral craniotomy was found to be one of the best treatments for central brain herniation to improve patient outcomes.
authors.affiliation: From the Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wu
authors.forename: Shao-Feng
authors.initials: SF
authors.lastname: Yang
authors.forename: Yong-Ming
authors.initials: YM
authors.lastname: Qiu
authors.forename: Jiong
authors.initials: J
authors.lastname: Dai
authors.forename: Shan-Quan
authors.initials: SQ
authors.lastname: Li
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Zhang
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: Miao
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D042241:Early Diagnosis; D004677:Encephalocele / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005624:Frontal Bone / Q000293:injuries*; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008636:Mesencephalon / Q000293:injuries; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012012:Red Nucleus / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult