Surgery for cerebral contusions: Rationale and practice

Mathai, KI; Sengupta, Shamik; Shashivadhanan,; Sudumbrekar, S.M.

doi:10.1016/s0973-0508(09)80022-1

Cited by 5 publications

(13 citation statements)

References 13 publications

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“…Here blunt injury is investigated and we are concerned primarily with the brain's pressure response, as intra-cranial pressure is regarded as a good indicator of injury severity and has been linked to the onset of cerebral contusions [11] , [16] , i.e. focal lesions characterised by tissue rupture and cortical bleeding [17] – [19] .…”

Section: Introductionmentioning

confidence: 99%

On the Pressure Response in the Brain due to Short Duration Blunt Impacts

Pearce

Young

2014

PLoS ONE

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When the head is subject to non-penetrating (blunt) impact, contusion-type injuries are commonly identified beneath the impact site (the coup) and, in some instances, at the opposite pole (the contre-coup). This pattern of injury has long eluded satisfactory explanation and blunt head injury mechanisms in general remain poorly understood. There are only a small number of studies in the open literature investigating the head's response to short duration impacts, which can occur in collisions with light projectiles. As such, the head impact literature to date has focussed almost exclusively on impact scenarios which lead to a quasi-static pressure response in the brain. In order to investigate the response of the head to a wide range of impact durations, parametric numerical studies were performed on a highly bio-fidelic finite element model of the human head created from in vivo magnetic resonance imaging (MRI) scan data with non-linear tissue material properties. We demonstrate that short duration head impacts can lead to potentially deleterious transients of positive and negative intra-cranial pressure over an order of magnitude larger than those observed in the quasi-static regime despite reduced impact force and energy. The onset of this phenomenon is shown to be effectively predicted by the ratio of impact duration to the period of oscillation of the first ovalling mode of the system. These findings point to dramatically different pressure distributions in the brain and hence different patterns of injury depending on projectile mass, and provide a potential explanation for dual coup/contre-coup injuries observed clinically.

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Section: Introductionmentioning

confidence: 99%

On the Pressure Response in the Brain due to Short Duration Blunt Impacts

Pearce

Young

2014

PLoS ONE

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“…9 The benefits of removing the contused brain include the removal of edema producing osmotic load and abolition of necrotic and apoptotic cascades triggered off by blood degradation products. 10 Contusion evacuation benefits patients of severe head injury with contusion and intractable intracranial hypertension. 11 The survival and functional outcome after these procedures are acceptable.…”

Section: Discussionmentioning

confidence: 99%

Minimally Access Surgery—“Burr Hole with Very Small Craniectomy” versus “Conventional Craniotomy” for Brain Contusions: An Institutional Experience

Mishra

Tripathy

2015

IJNT

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Objective?This article aims to compare surgical outcome of brain contusions treated by ?Conventional Osteoplastic/free bone flap craniotomy? (group A) with ?burr hole with very small craniectomy? (group B) and evaluate for better outcomes. Methods?A total of 672 patients of brain contusions, from August 2013 through July 2014, were reviewed retrospectively from the computerized discharge summaries of the neurosurgery trauma ward. The patients with brain contusions who were treated surgically (110), were then divided into group A??Conventional Osteoplastic/free bone flap craniotomy? (58?+?42?=?100) and group B??burrhole with minimal craniectomy?(10). Results?Overall, 562 patients were managed conservatively. Groups were compared for demographic data, computed tomographic findings, Glasgow Coma Scale, duration of surgery, hospital stay, mortality, and Glasgow outcome scale. Mass effect on noncontrast head computed tomography was more in group A, pupillary reaction was worse. Blood loss and duration of surgery were higher in group A. Rest other parameters were not significantly different. Mortality was 11% (11/100) in group A and 0% (0/10) in group B. Overall, 48% (48/100) patients in group A and 100% (10/10) in group B had satisfactory outcome. Conclusion??Burr hole with minimal craniectomy? in carefully selected contusion patients, who present with features of raised intracranial pressure clinically but not much radiographically, avoids a big flap. This approach minimizes blood loss and tissue handling and hence produces excellent outcome with minimal hospital stay.

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“…Results of recent randomized trial have shown that long-term outcome is worse for decompressive craniotomy. 15 The benefits of removing the contused brain include the removal of edema producing osmotic load and abolition of necrotic and apoptotic cascades triggered off by blood degradation products 16 ( Fig. 2a and b).…”

Section: Discussionmentioning

confidence: 99%

Surgical outcome of brain contusions treated by decompressive craniotomy with or without lobectomy at high volume tertiary care trauma centre

Sinha

Rathore

Mahapatra

et al. 2014

The Indian Journal of Neurotrauma

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Aims and objective To assess and compare surgical outcome of brain contusions treated by Decompressive craniotomy with or without lobectomy or contusectomy. Methods 156 patients of severe TBI, operated for brain contusions from January 2009 through December 2010 were reviewed. The patients with brain contusions >20 cm3 in volume were included in study. In group A, decompressive craniotomy with lax duraplasty was done; in group B decompressive craniotomy with lax duraplasty along with excision of brain contusion or lobectomy was performed. Results There were 101 patients in group A and 55 in group B. Both groups were compared for demographic data, CT findings, GCS, time from injury to surgery, duration of surgery, blood loss, hospital stay, mortality and Glasgow outcome scale. Contusions were larger in group B (p = 0.0001). Pupillary reaction was worse in group B (p = 0.037). The time from injury to presentation to casualty (p = 0.0033) and time from injury to surgery (p = 0.0008) was longer in group B. Blood loss (p = 0.0001) and duration of surgery (p = 0.0013) were higher in group B. Rest other parameters were not significantly different. In group A, mortality rate was 63% and 50% in group B (p = 0.131). 28% patients in group A and 42% in group B had good outcome (p = 0.073). Conclusions Adequate contusectomy or lobectomy is useful in severe TBI with contusions. The results of present series suggest that one should be very aggressive in managing brain contusions to achieve better outcomes.

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Surgery for cerebral contusions: Rationale and practice

Cited by 5 publications

References 13 publications

On the Pressure Response in the Brain due to Short Duration Blunt Impacts

On the Pressure Response in the Brain due to Short Duration Blunt Impacts

Minimally Access Surgery—“Burr Hole with Very Small Craniectomy” versus “Conventional Craniotomy” for Brain Contusions: An Institutional Experience

Surgical outcome of brain contusions treated by decompressive craniotomy with or without lobectomy at high volume tertiary care trauma centre

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