Delayed Surgery in Traumatic Brain Compression

Balyabin A.V., Kravec L.Ya.

Scientific Research Institute of Traumatology and Orthopedics, Nizhniy Novgorod, Moscow, Russia

 

Modern approaches to timing of intracerebral hematoma surgery are based on clinical and instrumental data and imply both performing urgent operations and conservative treatment. An intermediate position is occupied by delayed surgery, whose causes may be different.

The study goal has been analysis of causes and clinical outcomes of delayed operations for traumatic intracerebral hematomas.

Material and Methods. The results of treatment of 33 casualties (acute epidural hematomas 5, subdural hematomas 12, intracerebral hematomas 5, brain compression, caused by several factors 11) were analyzed. The patients were operated 2-12 days after trauma. Their initial treatment was conservative (decision was made on the basis of clinical and CT data).

Results and Discussion. All the cases were divided into 3 groups in compliance with causes of a failure of conservative treatment. Augmentation of focal or dislocation symptoms was watched in 15 cases. The state severity of these cases was characterized by the score of 11.1 (the Glasgow Coma Scale); dislocation of median structures was 7.7 mm. The second group included 12 cases; CT-examination revealed considerable increase of hematoma, whose initial volume had been rather small (the Glasgow Coma score of 12.1; dislocation of median structures 4.3 mm). The third group consisted of 6 cases with progression of parenchymal lesions and formation of intracerebral hematomas (the Glasgow Coma score of 12; dislocation of median structures 5.5 mm). Good functional results were watched on discharge of cases of the first and second groups (according to Glasgow Coma Scale). A mean period of treatment was 24.5 days.

Conclusion. Delayed operations are the result of inefficacy of well-grounded conservative treatment. Timely delayed operations do not worsen clinical outcomes.