Bifrontal Contusions: What Is the Best Surgical Treatment?

Problems Considered Bifrontal contusions are common and pose surgical dilemma regarding both indication as well as extent of surgery. There is no guideline available for optimal treatment of such lesions. The objective of this study was to determine the best modality of surgical treatment for such patients. Methods This is a retrospective study of patients who were surgically treated for bifrontal contusions during the last 5 years. Clinical features, computed tomographic scan findings, surgical treatment modality, in-hospital mortality, and follow-up data were recorded. Results A total of 98 patients (mean age 45 years) were operated for bifrontal contusions. Mean Glasgow coma score was 9 and motor response was M5. Contusions were of the same size on both sides in 22 cases and asymmetric in 76 cases. Patients underwent following surgical procedures: bifrontal decompressive craniectomy without evacuation of contusion (40 cases), bifrontal craniotomy and evacuation of bifrontal contusion (34 cases), and evacuation of unilateral contusion (24 cases). The overall mortality was 36.7%. The mortality was 55, 35.3, and 8.3%, respectively, with the above-mentioned surgical treatments. There was no difference in mortality between patients with symmetric and asymmetric contusions. The mean duration of follow-up was 23 months. Follow-up data were available for 42 (67.7%) survivors. Favorable outcome was seen in 80.9% of the survivors. Frontal lobe dysfunction was seen in 59.5% of the survivors. Conclusion Patients who underwent bifrontal decompressive craniectomy without evacuation of contusion had worst outcome. Variable removal of contused brain tissue is required for reducing mortality.