Surgical Decision-Making in Patients with Traumatic Contusion and Intracerebral Haematoma — ICP Monitoring or CT Scanning?

  • R. Bullock
  • G. T. Blake
Conference paper


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 [4]. 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 [5]. 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.


Midline Shift Basal Cistern Intracerebral Haematoma Surgical Evacuation Head Injured Patient 
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  1. 1.
    Becker DP, Miller JD, Ward JD, Choi SC, Lutz HA (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502PubMedCrossRefGoogle Scholar
  2. 2.
    Bullock R, Statham P, Patterson J, Wyper D, Hadley D, Teasdale E (1990) The time course of vasogenic oedema after focal human head injury. Evidence from SPECT mapping of blood brain barrier defects. Acta Neurochir, Suppl 51:286–288Google Scholar
  3. 3.
    Galbraith SL, Teasdale GM (1981) Predicting the need for operation in a patient with an occult traumatic intracranial haematoma. J Neurosurg 55:75–81CrossRefGoogle Scholar
  4. 4.
    Jamieson KG, Yelland JDW (1972) Traumatic intracerebral haematoma. Report of 63 surgically treated cases. J Neurosurg 37:528–531PubMedCrossRefGoogle Scholar
  5. 5.
    Toutant SM, Klauber MR, Marshall LF, Toole BM, Bowers SA, Seelig JM, Varnell JB (1984) Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691–694PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • R. Bullock
    • 1
  • G. T. Blake
    • 1
  1. 1.Department of Neurosurgery, Institute of Neurological SciencesSouthern General HospitalGlasgowScotland

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