Current Consideration Regarding Operative Versus Non-Operative Outcome of Brain Contusion Patients

Abstract

Background: Brain contusion surgeries versus conservative treatment are considered to be the typical decisions faced by doctors, resolved usually based on the experience of respective departments. Till date there are no standard guidelines regarding conservative versus surgical management. Objective: To determine the outcome of the surgical and medical management in posttraumatic brain contusion patients. Methods: The study was conducted on patients having small and large brain contusions admitted in the department were selected through custom Proforma. The 41 patients (31 males 10 females) included corresponded to no specific exclusion criteria. The patients who improved by Glasgow coma score, neurologically or resolution was confirmed by Computed tomography scan brain were categorized under conservative management. While the patients, who deteriorated by Glasgow coma score, neurologically, bradycardia or showed expansion in the size of contusion with mass effect underwent standard decompressive craniotomy or cranectomy and evacuation of contusions along with duroplasty. Complications and improvement of the patients were determined at follow up and monitored by the help of interval brain CT scan during their stay in the department subsequently followed by cranioplasties. Results: There was a male predilection with male to female ratio of 3.1:1. The age group more frequently affected was 20-40 years and the most causative agent was road trauma accident. Complications were found among two patients as intractable seizures, brain abscess formation, hydrocephalus and post operative jaundice in one patient each. Wound infections in four patients. Overall outcome was good in conservative and surgical intervention patients of brain contusions. The total mortality was four patients, two in each group of patients. Conclusion: Therefore we recommend that nonsurgical and surgical management has comparable results, but surgical decompressive craniotomy is the mainstay of treatment based on the essential monitoring tools as repeated interval scanning and neurological evaluation considering the timing of surgery, volume and size of hematoma, conscious status, bradycardia and hypertension. Key Words: Post Traumatic Brain Contusions, Glasgow Coma Score, Outcome.