Available online 9 January 2013
Publication year: 2013
Source:World Neurosurgery
Background With the development of edema and possible hemorrhagic contusion enlargement, patients with bifrontal contusion may deteriorate rapidly or even die due to central brain herniation. Therefore, close monitoring and in time treatment may be important to these patients. Methods A 127 patients with bifrontal contusions were reviewed retrospectively. Among them, 63 patients accepted operations, 39 cases underwent intracranial pressure (ICP) monitoring, and 24 cases did not. We compared the Glasgow Outcome Scale (GOS) for prognosis, length of osmolar therapy, and length in intensive care unit (ICU) and hospital stay between ICP and non-ICP groups. Results Compared with the non-ICP operation group, there was no significant difference in GCS in the ICP group, both upon admission (average 8.62 vs. 8.91, P=0.711) and at discharge (average 11.32 vs. 10.45, P=0.427). However, the length of ICU stay was much shorter in the ICP operation group than that of the non-ICP group (15.67±8.72d vs. 25.32±18.78d, P=0.013). Hospital stay was also shortened significantly in the ICP operation group compared with the non-ICP operation group (18.94±8.92d vs. 34.29±22.64d, P=0.001). The length of osmolar therapy with mannitol was also decreased in the ICP operation group compared with the non-ICP group (14.11±6.65d vs. 21.84±12.02, P=0.008). However, there was no difference in mortality between two groups (5/39 vs. 4/24). We followed up twenty-nine ICP operation patients and nineteen non-ICP operation patients using GOS six months later. The average GOS was 4.21 and 3.32 for the ICP and non-ICP groups respectively (P=0.025). Conclusion ICP is one of the most important intensive monitorings for patients with moderate to severe bifrontal contusions, and may be beneficial for better prognosis. Intensive care and proper management are necessary to reduce stays in ICU, hospitalization, and mannitol osmolar therapy, and to improve GOS.
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