Treatment strategies of bifrontal contusions and analysis of related risk factors for progress deterioration

Objective To investigate the treatment strategies of bifrontal contusions and the related risk factors for progress deterioration. Methods The clinical data of 61 patients with bifrontal contusions treated from December 2011 to December 2014 were analyzed retrospectively. All patients performed the probe implantion of intraventricular intracranial pressure after admission. Postoperative intracranial pressure and drainage of cerebrospinal fluid were monitored continuously. When the disease progressed and deteriorated, the craniotomy was performed immediately. Results The conditions of 38 patients (62%) were not worsening and were treated conservatively; those of 23 patients (38%) were worsening and were treated surgically. There was significant difference in the prognoses between the two groups (P>0.05). The angle between the frontal horns >120°, scattered frontal contusion, frontal hematoma (edema) over bilateral sphenoid ridge line were the independent risk factors for leading to the occurrence of deterioration (P<0.05). Conclusions Intracranial pressure monitoring is the basis for the treatment of bifrontal contusions. Strictly controlling the intracranial pressure under the 20 mm Hg by using cerebrospinal fluid drainage and other therapeutic measures is the key to the success of conservative treatment. The angle between the frontal horns >120° can be used as a quantitative indication of craniotomy, at the same time, scattered frontal contusion, frontal hematoma (edema) over bilateral sphenoid ridge line can also be used as the reference indices of craniotomy. Key words: Craniocerebral injury; Intracranial pressure; Cerebral contusion; Risk factors