Surgical management of traumatic parenchymal lesions.

M. Ross Bullock, Randall Chesnut, Jamshid Ghajar, David Gordon, Roger Hartl, David W. Newell, Franco Servadei, Beverly C. Walters, Jack Wilberger

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

INDICATIONS: Patients with parenchymal mass lesions and signs of progressive neurological deterioration referable to the lesion, medically refractory intracranial hypertension, or signs of mass effect on computed tomographic (CT) scan should be treated operatively. Patients with Glasgow Coma Scale (GCS) scores of 6 to 8 with frontal or temporal contusions greater than 20 cm3 in volume with midline shift of at least 5 mm and/or cisternal compression on CT scan, and patients with any lesion greater than 50 cm3 in volume should be treated operatively. Patients with parenchymal mass lesions who do not show evidence for neurological compromise, have controlled intracranial pressure (ICP), and no significant signs of mass effect on CT scan may be managed nonoperatively with intensive monitoring and serial imaging. TIMING AND METHODS: Craniotomy with evacuation of mass lesion is recommended for those patients with focal lesions and the surgical indications listed above, under Indications. Bifrontal decompressive craniectomy within 48 hours of injury is a treatment option for patients with diffuse, medically refractory posttraumatic cerebral edema and resultant intracranial hypertension.Decompressive procedures, including subtemporal decompression, temporal lobectomy, and hemispheric decompressive craniectomy, are treatment options for patients with refractory intracranial hypertension and diffuse parenchymal injury with clinical and radiographic evidence for impending transtentorial herniation.

Original languageEnglish (US)
JournalNeurosurgery
Volume58
Issue number3 Suppl
StatePublished - Mar 2006
Externally publishedYes

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Intracranial Hypertension
Decompressive Craniectomy
Glasgow Coma Scale
Contusions
Craniotomy
Brain Edema
Wounds and Injuries
Intracranial Pressure
Decompression
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Bullock, M. R., Chesnut, R., Ghajar, J., Gordon, D., Hartl, R., Newell, D. W., ... Wilberger, J. (2006). Surgical management of traumatic parenchymal lesions. Neurosurgery, 58(3 Suppl).

Surgical management of traumatic parenchymal lesions. / Bullock, M. Ross; Chesnut, Randall; Ghajar, Jamshid; Gordon, David; Hartl, Roger; Newell, David W.; Servadei, Franco; Walters, Beverly C.; Wilberger, Jack.

In: Neurosurgery, Vol. 58, No. 3 Suppl, 03.2006.

Research output: Contribution to journalArticle

Bullock, MR, Chesnut, R, Ghajar, J, Gordon, D, Hartl, R, Newell, DW, Servadei, F, Walters, BC & Wilberger, J 2006, 'Surgical management of traumatic parenchymal lesions.', Neurosurgery, vol. 58, no. 3 Suppl.
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006 Mar;58(3 Suppl).
Bullock, M. Ross ; Chesnut, Randall ; Ghajar, Jamshid ; Gordon, David ; Hartl, Roger ; Newell, David W. ; Servadei, Franco ; Walters, Beverly C. ; Wilberger, Jack. / Surgical management of traumatic parenchymal lesions. In: Neurosurgery. 2006 ; Vol. 58, No. 3 Suppl.
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