Abstract
BackgroundTraumatic acute bilateral mass-occupying lesions (TABML) is a common entity in head injury, with high morbidity and mortality. Our aim in this study was to evaluate the benefits of different treatment options and the outcome predictors in patients with TABML.MethodsFrom October 2010 to November 2012, a consecutive cohort of patients aged 16–70 years with TABML were retrospectively analyzed based on the clinical and radiological characteristics. Patients with TABML were included if admitted within 24 h after injury and were excluded if they presented with infratentorial lesions, unilateral lesions within the first 24 h after injury, or penetrating head injury. According to their treatment option, patients were divided into three groups: a conservative treatment group, a unilateral surgery group, and a bilateral surgery group. Outcomes were assessed using the Glasgow Outcome Scale (GOS). Binary logistic regression analysis was applied to determine the outcome predictors.ResultsForty-seven patients (58.8%) had severe injuries (Glasgow Coma Scale score (GCS), 3–8) upon admission, and the overall mortality was 31.3% at 6 months post-injury. The mortality was 55.6% in patients who underwent conservative treatment (N = 18), 17.9% in unilateral surgery patients (N = 39), and 34.8% in the bilateral surgery group (N = 23). In the surgical group, the mortality was 53.3% (8 of 15) in those with a GCS of 3–5, which decreased steeply to 14.9% (7 of 47) of those with GCS ≥ 6. On logistic regression analysis, the absence of pupillary reactivity, disappearances of basal cisterns and conservative treatment were related to higher mortality. A lower initial GCS score was associated with an unfavorable outcome. Midline shift tended to be associated with mortality and an unfavorable outcome, although statistical analysis did not show a significant difference.ConclusionsTABML is suggestive of severe brain injury. As conservative treatment is always associated with a poorer outcome, surgery is advocated, especially in patients with a GCS score of ≥ 6. Whereas the prognostic value of midline shift might be limited because of the counter-mass effect in TABML, the GCS score, the pupillary reactivity, and particularly, the compression of basal cisterns should be emphasized.
Highlights
Traumatic acute bilateral mass-occupying lesions (TABML) is a common entity in head injury, with high morbidity and mortality
We found that the Glasgow coma scale (GCS) score, the pupillary reactivity, and the compression of basal cisterns are important prognostic predictors in TABML
According to GCS score, the most important predictor of the severity of Traumatic brain injury (TBI), we found that bilateral surgery was commonly performed in patients with more severe injuries in comparison with those who underwent unilateral surgery (GCS, 6.7 ± 3.3 VS 9.2 ± 3.7; p < 0.05)
Summary
Traumatic acute bilateral mass-occupying lesions (TABML) is a common entity in head injury, with high morbidity and mortality. EDH, SDH, and HC are common types of acute mass-occupying lesions, which can be observed in various combinations (e.g., SDH with HC), in patients with severe head injury [2,5-7]. These massoccupying lesions may present unilaterally or bilaterally on the computed tomography (CT) scans [8-10]. Traumatic acute bilateral mass-occupying lesions (TABML) is a common entity after contre-coup injury, with an estimated mortality ranging from 20% to 79%; the optimal treatment options and the prognostic indicators for TABML are largely unknown [4,5,8-12]. Whether the MLS and other predictors, such as the compression of basal cisterns, correlated with outcomes in TABML has not been extensively studied [3,5]
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