Surgical Treatment of Traumatic Bifrontal Contusions: When and How?

OBJECTIVE: The study aimed to investigate optimal surgical timing, methods, and clinical efficacy of bifrontal decompression craniotomy (BDC) on traumatic bifrontal contusions (TBC). METHODS: A retrospective analysis was performed of 98 patients with TBC who underwent BDC of 2510 patients with traumatic brain injury. The operation-timing score was used to determine surgical timing. RESULTS: Ninety-eight cases (19%) underwent amended BDC. Initial Glasgow Coma Score was 13-15 in 52 cases (61%). Initial computed tomography showed hematoma volumes of 15.1 +/- 5.2 mL in 73 cases (74%). Preoperative hematoma (80.2 +/- 20.5 mL; P < 0.05) was significantly enlarged. Fluctuation in the surgery-timing curve is timing for surgery. Average operation time was 4.5 +/- 3.4 days after admission. Hematoma was totally evacuated and Glasgow Coma Score significantly increased (P < 0.05) in all cases. In the follow-up Glasgow Outcome Score, 79 patients (81%) recovered well. CONCLUSIONS: TBC progressed gradually and deteriorated rapidly; this should be strictly and dynamically observed, and patients should be operated on in a timely manner. Changing the operation-timing score is the gold standard for surgery. Amended BDC can significantly improve the prognosis of patients.