Download PDF
CC BY 4.0 · Indian Journal of Neurosurgery 2024; 13(01): 044-052
DOI: 10.1055/s-0043-1774813
Original Article

A Study to Evaluate Prognostic Factors and Define a Critical Volume for Early Surgery in Patients with Bifrontal Brain Contusions

Manoranjitha Kumari M
1   JIPMER, Puducherry, India
,
T.P. Jeyaselva Senthilkumar 
2   Faculty of Medical & Health Sciences, SRM Institute of Science and Technology, SRM Medical College Hospital and Research Centre, Kattankulathur, Chenglepet, Tamil Nadu, India
,
Yamunadevi Ravi
3   Department of Community Medicine, Govt. Stanley Medical College, Chennai
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Aim The aim of this study was to evaluate various prognostic factors and their impact on the outcome of patients with bifrontal brain contusions and to define the critical volume of bifrontal brain contusions and to advice early surgery

Materials and Methods This is a prospective study performed with 250 patients admitted in a tertiary care hospital in Chennai.

Observations and Results In this study, we have studied the various findings in computed tomography (CT) scan brain that haves influence over the outcome. These are: Bilateral squashing of frontal horn, Posterior shift of genu, The deformation of third ventricle, The complete obliteration of basal cisterns, 5. Development of delayed intracranial hemorrhage (ICH). All these factors are associated with worst outcome and in patients those developed delayed increase in contusion volume, the median volume of contusion at the admission time ranged from 22 to 32 mL and the mean being 27 mL, we recommend prophylactic surgery in this subset of patients to prevent them from developing rapid deterioration in Glasgow coma scale (GCS) due to delayed ICH.

Conclusion Critical volume of bilateral frontal contusion that warrants prophylactic surgical intervention irrespective of the admission GCS is 27 mL. Younger age and good admission GCS are independent predictors for better outcome. Patients with volume of contusion more than 50 mL are always associated with unfavorable outcome. Bilateral frontal horn squashing, anteroposterior shift of genu of corpus callosum, deformation of third ventricle, and obliteration of basal cisterns are CT predictors for poor outcome in bifrontal brain contusions.

Keywords

bifrontal contusions - early surgery - frontal contusions


Publication History

Article published online:
12 October 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Guha A. Management of traumatic brain injury: some current evidence and applications. Postgrad Med J 2004; 80 (949) 650-653
    CrossrefPubMedGoogle Scholar
  • 2 Lobato RD, Cordobes F, Rivas JJ. et al. Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 1983; 59 (05) 762-774
    CrossrefPubMedGoogle Scholar
  • 3 Suresh HS, Praharaj SS, Indira Devi B, Shukla D, Sastry Kolluri VR. Prognosis in children with head injury: an analysis of 340 patients. Neurol India 2003; 51 (01) 16-18
    PubMedGoogle Scholar
  • 4 Zhaofeng L, Bing L, Peng Q, Jiyao J. LuZhaofeng. Surgical treatment of traumatic bifrontal contusions: when and how?. World Neurosurg 2016; 93: 261-269
    CrossrefPubMedGoogle Scholar
  • 5 Patel R, Shankar KB. Assess management and outcome of patients with traumatic bifrontal contusion. Int J Sci Res 2020; 9 (05) 1397-1399
    PubMedGoogle Scholar
  • 6 Rehman T, Ali R, Tawil I, Yonas H. Rapid progression of traumatic bifrontal contusions to transtentorial herniation: a case report. Cases J 2008; 1 (01) 203
    CrossrefPubMedGoogle Scholar
  • 7 Statham PF, Johnston RA, Macpherson P. Delayed deterioration in patients with traumatic frontal contusions. J Neurol Neurosurg Psychiatry 1989; 52 (03) 351-354
    CrossrefPubMedGoogle Scholar
  • 8 Hung KS, Liang CL, Wang CH, Chang HW, Park N, Juo SH. Outcome after traumatic frontal intracerebral haemorrhage: a comparison of unilateral and bilateral haematomas. J Clin Neurosci 2004; 11 (08) 849-853
    CrossrefPubMedGoogle Scholar
  • 9 Sarma P, Shukla DP, Devi BI, Contusions B. What is the best surgical treatment?. Indian J Neurotrauma (e-pub ahead of print). DOI: 10.1055/s-0035-1570095/2015.
    CrossrefPubMedGoogle Scholar
  • 10 Patel NY, Hoyt DB, Nakaji P. et al. Traumatic brain injury: patterns of failure of nonoperative management. J Trauma 2000; 48 (03) 367-374 , discussion 374–375
    CrossrefPubMedGoogle Scholar
  • 11 Senthil Kumar TPJ, Chinnamuthu S, Kunjithapatham D. Role of routine follow-up CT brain at 24hrs and 48hrs in clinically stable mild head injury patients – is it cost-effective?. Int J Sci Res 2019; 8 (06) 45-47
    PubMedGoogle Scholar
  • 12 Van de Zande N, Manivannan S, Sharof F. et al. demographics, presentation and clinical outcomes after traumatic bifrontal contusions: a systematic review. Neurosurgical Review 2020; 43: 977-986
    CrossrefPubMedGoogle Scholar
  • 13 Wu H, Yang SF, Qiu YM. et al. The diagnosis and surgical treatment of central brain herniations caused by traumatic bifrontal contusions. J Craniofac Surg 2014; 25 (06) 2105-2108
    CrossrefPubMedGoogle Scholar
  • 14 Steyerberg EW, Mushkudiani N, Perel P. et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008; 5 (08) e165 , discussion e165
    CrossrefPubMedGoogle Scholar
  • 15 Jayakumar PN, Sastry Kolluri VR, Basavakumar DG. et al. Prognosis in contre-coup intracranial haematomas–a clinical and radiological study of 63 patients. Acta Neurochir (Wien) 1991; 108 (1-2): 30-33
    CrossrefPubMedGoogle Scholar
  • 16 Bhateja A, Shukla D, Devi BI, Kolluri VRS. Coup and contrecoup head injuries: predictors of outcome. Indian J Neurotrauma (IJNT) 2009; 6 (02) 115-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Bullock Ross, Chestnut Randall. et al. Guidelines for the surgical management of TBI. Neurosurgery 2006; 58 (S2): 25-46
    PubMedGoogle Scholar
  • 18 Gallbraith S, Teasdale G. Predicting the need for operation in the patient with an occult traumatic intracranial hematoma. J Neurosurg 1981; 55 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 19 Park ES, Moon SK, Eom KS. Comparison of the surgical approaches for frontal traumatic intracerebral hemorrhage. J Trauma Inj 2019; 32 (02) 71-79
    CrossrefPubMedGoogle Scholar
  • 20 Oh HJ, Hwang SC. Supraorbital endoscopic evacuation for traumatic intracerebral hematomas in the frontal lobe. J Korean Neurosurg Soc 2022; 65 (06) 846-852
    CrossrefPubMedGoogle Scholar