Surgical Treatment of Traumatic Bifrontal Contusions: When and How?
OBJECTIVE
The study aimed to investigate optimal surgical timing, methods, and clinical efficacy of bifrontal decompression craniotomy (BDC) on traumatic bifrontal contusions (TBC).


METHODS
A retrospective analysis was performed of 98 patients with TBC who underwent BDC of 2510 patients with traumatic brain injury. The operation-timing score was used to determine surgical timing.


RESULTS
Ninety-eight cases (19%) underwent amended BDC. Initial Glasgow Coma Score was 13-15 in 52 cases (61%). Initial computed tomography showed hematoma volumes of 15.1 ± 5.2 mL in 73 cases (74%). Preoperative hematoma (80.2 ± 20.5 mL; P < 0.05) was significantly enlarged. Fluctuation in the surgery-timing curve is timing for surgery. Average operation time was 4.5 ± 3.4 days after admission. Hematoma was totally evacuated and Glasgow Coma Score significantly increased (P < 0.05) in all cases. In the follow-up Glasgow Outcome Score, 79 patients (81%) recovered well.


CONCLUSIONS
TBC progressed gradually and deteriorated rapidly; this should be strictly and dynamically observed, and patients should be operated on in a timely manner. Changing the operation-timing score is the gold standard for surgery. Amended BDC can significantly improve the prognosis of patients.
Department of Neurosurgery Intensive Care Unit, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China. Electronic address: zhaofenglu001@163.com.
Lu
L
Zhaofeng
Department of Neurosurgery Intensive Care Unit, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
Li
L
Bing
Department of Neurosurgery Intensive Care Unit, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
Qiao
Q
Peng
Department of Neurosurgery, Renji Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.
Jiang
J
Jiyao
D000328:Adult; D000070624:Brain Contusion / Q000401:mortality* / Q000601:surgery*; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D056424:Decompressive Craniectomy / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006407:Hematoma, Epidural, Cranial / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
Bifrontal contusions; Bifrontal decompression craniotomy; Timing of operation