Surgical Decision-Making in Patients with Traumatic Contusion and Intracerebral Haematoma — ICP Monitoring or CT Scanning?
With the increasing use of CT scanning after head injury, many patients who have intrinsic cerebral mass lesions such as contusion and intracerebral haematoma will present to the neurosurgeon conscious, without prior neurological deterioration . Experience has shown that most of these patients will tolerate their haematomas and recover within the limitations of the extent of the focal damage sustained . However, a minority may deteriorate or die due to raised intracranial pressure because of delayed swelling of the mass lesion or the surrounding brain. Patient selection for prophylactic surgery is, therefore, crucial in this group of patients. We have reviewed the results of ICP monitoring as a means to assist surgical decision-making in a group of 85 patients with traumatic intracerebral haematomas in whom doubt existed about the need for surgical evacuation. We have also retrospectively reviewed the CT scan findings in the same patients in order to formulate guidelines for optimal management of this difficult group of patients.
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