Bilateral Craniotomies for Blunt Head Trauma

Abstract

Development of delayed or recurrent intracranial hematomas requiring reexploration or a secondary craniotomy is well known. Patients with bilateral pathology requiring bilateral craniotomies as the initial emergency operative intervention, however, are uncommon. The lack of available literature and the large volume of head trauma seen at our institution prompted us to analyze the retrospective data on blunt head injury requiring bilateral craniotomies. Twenty patients underwent bilateral craniotomies at the University of Miami/Jackson Memorial Medical Center between January 1986 and June 1994. Ages ranged from 18 to 85 years. Mechanism of injury included motor vehicle crash (n = 4), pedestrian hit by automobile (n = 4), assault (n = 8), fall from height (n = 3), and unknown (n = 1). Epidural hematomas, acute subdural hematomas, contusions, and intracerebral hematomas were seen in varying combinations. The preoperative Glasgow Coma Scale (GCS) score ranged from 4 to 14, with a mean of 8.8 (+/-0.82 SE). Sixteen of the 20 patients survived and were discharged from the hospital. The survivors' Rancho Los Amigos Scale score on discharge ranged from 2 to 8, with a mean of 6.1 (+/-0.45 SE). A Fisher's exact test was performed to compare the outcome between the patients with mild (GCS score 13-15) to moderate (GCS score 9-12) head injury and those with severe (GCS score 4-8) head injury. It showed a statistically higher frequency of death in the severe category (p < 0.05). In conclusion, the outcome of patients with bilateral pathology requiring emergency bilateral craniotomy at initial treatment correlated well with their GCS scores at initial presentation.

Acute bilateral mass-occupying lesions in non-penetrating traumatic brain injury: a retrospective study

“…Early prediction of outcomes is not only of great importance in clinical decision-making, but also is useful for stratification of patients for clinical trials and comparison of outcomes of different series [ 3 , 14 ]. The Glasgow coma scale (GCS) score on admission is a powerful independent predictor in TBI, a fact demonstrated in patients with TABML in previous studies [ 5 , 12 ]. The midline shift (MLS), another important predictor in TBI, is usually of less significance in bilateral than in unilateral abnormalities because of the counter-mass effect [ 3 – 5 , 7 , 12 , 15 ].…”

“…Traumatic brain injury (TBI) is a heterogeneous entity that encompasses several anatomical patterns, including epidural hematoma (EDH), subdural hematoma (SDH), hemorrhagic contusion (HC), diffuse axonal injury, subarachnoid hemorrhage, intraventricular hemorrhage, and diffuse brain swelling on the macroscopic level [ 1 – 4 ]. EDH, SDH, and HC are common types of acute mass-occupying lesions, which can be observed in various combinations (e.g., SDH with HC), particularly in patients with severe head injury [ 2 , 5 – 7 ]. These mass-occupying lesions may also 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%; however, the optimal treatment options and the prognostic indicators for TABML are largely unknown [ 4 , 5 , 8 – 12 ]. Whether all patients with TABML will benefit from surgical intervention and, if surgery is performed, whether surgical intervention should be based on predominantly mass-occupying lesions (unilateral) or bilateral lesions [ 5 , 7 – 10 , 13 ], remain under discussion. Early prediction of outcomes is not only of great importance in clinical decision-making, but also is useful for stratification of patients for clinical trials and comparison of outcomes of different series [ 3 , 14 ].…”

Quality of life after hemicraniectomy for traumatic brain injury in adults

“…1,2,4-7,9,11, [14][15][16]18,19,21,22,25,[27][28][29][31][32][33][34][35][36][37][38][39][40] The mean years of patient accrual were between 1987 and 2005. Total numbers in each GOS category are shown in Table 1.…”

Defining meaningful outcomes after decompressive craniectomy for traumatic brain injury: Existing challenges and future targets

“…Of the 28 studies reviewed here, all but seven used it exclusively [3,5,8,29,34,49]. The results of the GOS were most commonly dichotomized into Favourable (GOS ¼ 4-5), Unfavourable (GOS ¼ 2-3) and dead (GOS ¼ 1).…”