Surgery For Frontal Brain Contusion Patients During Diencephalon Period

Objective:To explore the clinical characteristics,surgical methods,surgical timing and treatment experience of frontal lobe contusion and laceration,and to advocate early judgment of diencephalon period of frontal lobe contusion and laceration and give the patients early operation to improve the prognosis of patients.Method:43 cases of frontal brain contusion patients operated by micro-surgery method during diencephalon period were selected from the Department of Neurosurgery between January 2012 and November 2015,and a retrospective analysis was performed.According to the name Plum of brain center hernia grading,we divide 60 patients into two groups(Group diencephalon and group non diencephalon).All the other patients were treated in time and underwent emergency craniotomy hematoma removal under general anesthesia.Unilateral craniotomy or bilateral craniotomy was determined according to the size and location of the hematoma.The removal of the bone flap was determined according to intraoperative conditions.Results: GCS score has a different degree of rise after the surgical operation.The compression of the anterior horn of lateral ventricle can be alleviated in most of patients.All patients were observed for 6 months to 2 years,and we used GOS score to evaluate the prognosis of the patients.Among the group diencephalon(36 patients)18 patients recovered as normal,returned to society and recovered well.16 patients had mild disability,2 patients had severe disability.Among the group non diencephalon(24 patients),2 patients had mild disability,18 patients had severe disability,4patints are dead.The surgical prognosis in diencephalon period is much better than those who did in non diencephalon period,Conclusion:1.Frontal lobe contusion in patients with early disease incidence is lighter.Brain center hernia is often the case in frontal lobe contusion,especially in bifrontal lobe contusion.Brain center hernia is a special type of cerebral hernia which clinical symptoms and signs of mild is not easy to get the patient’s family and clinicians’ attention,leading to clinical doctors can not correctly grasp the operation indication.when condition for the development of cerebral hernia,morbidity and mortality is higher.We should early recognize frontal lobe contusion of brain center hemia clinical manifestation and signs,and analysis of imaging examination,correctly identify diencephalon,strive for early surgery.2.According to the patient’s clinical symptoms,bilateral miosis,pathological character positive on both sides and urinary incontinence are typical symptoms and signs in brain center hernia diencephalon period.When CT imaging showed bilateral frontal lateral ventricle Angle more than 120 °,and scope of bilateral frontal lobe hematoma and edema is greater than bilateral sphenoid ridge of attachment,we need to alert the brain hernia diencephalon period.In non diencephalon period of brain center hernia,patients not only have bilateral lateral ventricle being pressed, accompanied by ambient cistern,quadrigemina cistern and suprasellar cistern being pressed or disappeared.This is deterioration of performance in patients.3.According to the patient’s clinical symptoms,imaging examination in the position of the hematoma,and scope,we should choose the proper operation method.We should decide to use unilateral or bilateral invasive craniotomy according to the scope of the area of brain contusion.We also should use the skilled processes operation in an emergency which can be timely and effective to reduce intracranial pressure,avoid blind to decompression.4.We strongly advocated the use of ICP monitoring which can provide theoretical clues for the management of the preoperative and postoperative intracranial pressure.The theory of underwent controlled stepped type decompression can reduce complications of patients significantly.ICP monitoring can effectively monitor intracranial pressure during surgery,decide whether to provide evidence for decompression craniotomy and reduce the patient’s treatment and the economic burden.But the relationship between ICP monitoring and brain center hernia diencephalon phase of the bifrontal lobe contusion and there is no literature reported that needs further research.