Technique of ICP Monitored Stepwise Intracranial Decompression Effectively Reduces Postoperative Complications of Severe Bifrontal Contusion.

Guan Sun,Shuguang Zhang,Tianhong Pan,Lei Shi,Xiaoliang Li

doi:10.3389/fneur.2016.00056

Abstract

Bifrontal contusion is a common clinical brain injury. In the early stage, it is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and therefore requires surgery. Conventional decompression craniectomy is the commonly used treatment method. In this study, the effect of intracranial pressure (ICP) monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated. A total of 136 patients with severe bifrontal contusion combined with deteriorated intracranial hypertension admitted from March 2001 to March 2014 in our hospital were selected and randomly divided into two groups, i.e., a conventional decompression group and an ICP monitored stepwise intracranial decompression group (68 patients each), to conduct a retrospective study. The incidence rates of acute intraoperative encephalocele, delayed hematomas, and postoperative cerebral infarctions and the Glasgow outcome scores (GOSs) 6 months after the surgery were compared between the two groups. (1) The incidence rates of acute encephalocele and contralateral delayed epidural hematoma in the stepwise decompression surgery group were significantly lower than those in the conventional decompression group; the differences were statistically significant (P < 0.05); (2) 6 months after the surgery, the incidence of vegetative state and mortality in the stepwise decompression group were significantly lower than those in the conventional decompression group (P < 0.05); the rate of favorable prognosis in the stepwise decompression group was also significantly higher than that in the conventional decompression group (P < 0.05). The ICP monitored stepwise intracranial decompression technique reduced the perioperative complications of traumatic brain injury through the gradual release of ICP and was beneficial to the prognosis of severe traumatic brain injury treatment.

Highlights

Bifrontal contusion is clinically common and mainly caused by direct impact on the forehead or either accelerated or decelerated force exerted on the occipital region (1)
Based on the clinical manifestations of central brain herniation or the diencephalon period, and combined with imaging features, it is believed that decompression craniectomy should be performed as early as possible to reduce the mortality and disability rate derived from central herniations caused by bifrontal contusions and to improve the cure rate of bifrontal contusion
We found that the intracranial pressure (ICP) monitored stepwise intracranial decompression technique can effectively treat intraoperative acute encephalocele and can reduce the incidence of the contralateral delayed epidural hematoma, which is vital to the improvement of prognosis of patients with severe bifrontal contusion

Summary

Introduction

Bifrontal contusion is clinically common and mainly caused by direct impact on the forehead or either accelerated or decelerated force exerted on the occipital region (1). Bifrontal contusion can cause emergency central herniation, leading to severe disability or death. Based on the clinical manifestations of central brain herniation or the diencephalon period, and combined with imaging features, it is believed that decompression craniectomy should be performed as early as possible to reduce the mortality and disability rate derived from central herniations caused by bifrontal contusions and to improve the cure rate of bifrontal contusion. Acute encephalocele is a critical situation in a conventional severe bifrontal decompression craniectomy (2); once this condition occurs, it is catastrophic for the patient, and the surgeon bears an enormous psychological burden. It is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and requires surgery. The effect of intracranial pressure (ICP) monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated

Methods

Results

Conclusion