Value of ventricular intracranial pressure monitoring and process management for traumatic bifrontal contusions

Abstract

Objective To investigate clinical efficacy and optimal therapeutic strategy for ventricular intracranial pressure (ICP) monitoring and process management in patients with traumatic bifrontal contusions (TBC). Methods Total 387 TBC patients between January 2010 and January 2016 were enrolled in 904th Hospital of Chinese PLA, in which 105 patients with TBC who underwent ventricular ICP monitoring (ICP group) and 282 patients with TBC who did not (non⁃ICP group). Conservative treatment and surgical treatment were performed respectively (unilateral craniotomy for contusion and hematoma removal, bilateral craniotomy for contusion and hematoma removal, and decompressive craniotomy). Rates of successful conservative treatment, ratio of bilateral craniotomy and decompressive craniectomy, length of stay, medical expenses and incidence of related complications were compared between 2 groups. Glasgow Outcome Scale (GOS) was used to assess all patients after 6 months follow⁃up. Results Compared with non⁃ICP group, ICP group had a significantly better successful conservative treatment rate [64.76% (68/105) vs. 47.16% (133/282); χ2=9.493, P=0.002], lower decompressive craniectomy rate [8.11% (3/37) vs. 23.49% (35/149); χ2=4.314, P=0.038]; shorter length of stay [(13.22 ± 1.83) d vs. (18.51 ± 5.08) d; t=10.410, P=0.000] and lower medical expenses [(8.34 ± 3.26) ten thousand yuan vs. (9.67 ± 4.42) ten thousand yuan; t=2.811, P=0.004]. No significantly difference in operative methods (χ2=2.673, P=0.102), pulmonary infection [33.33% (35/105) vs. 39.72% (112/282); χ2=1.321, P=0.250], intracranial infection [10.47% (11/105) vs. 8.16% (23/282); χ2=0.513, P=0.473], hydrocephalus [3.81% (4/105) vs. 6.74% (19/282); χ2=1.173, P=0.279], epilepsy [6.67% (7/105) vs. 10.99% (31/282); χ2=1.617, P=0.203] and bradycardia [28.57% (30/105) vs. 34.75% (98/282); χ2=1.320, P=0.251]. There were no significant differences in prognosis between 2 groups (χ2=1.492, P=0.474). Conclusions Condition of patients with TBC progresses rapidly. Patients should undergo ventricular ICP probe implantation in a timely manner. Although ventricular ICP monitoring do not significantly improve the prognosis of patients, it can increase the success rate of conservative treatment, reduce the rate of decompressive craniectomy, shorten the length of stay, and reduce the medial expenses. Ventricular ICP monitoring warrants further clinical research.

Keywords

• brain contusion
• frontal lobe
• intracranial pressure
• neurosurgical procedures