The Treatment Of Unilateral Surgical Approach To The Patient With Bilateral Frontal Lobe Laceration

Objective: A case-control study of unilateral approach surgery and bilateral surgery to therapy for the patient with severe bruise of bilateral frontal lobes. To investigate the mechanisms of the two procedures, clinical features and differences in efficacy. Provide a reference for clinical preferred surgical procedure.Methods: The 72 cases of patients with bilateral frontal brain contusion while performed by surgery were selected in Shenyang Military Region General Hospital from January 2013 to October 2014. The 36 cases featured the asymmetry damage stove by lighter side or the opposite side damage foci of surgical approach near the midline and the posterior of damage foci not more than the line between anterior corpus callosum and anterior lateral fissure were selected to unilateral surgical approach group while as the observation group. The remaining 36 cases were selected to bilateral surgical approach group as the control group. Before surgery all patients signed informed consent procedure, and in accordance with the requirements of "TBI clinical treatment guidelines" to perform strictly. Two groups of patients were given lumbar drainage or lumbar puncture for intracranial pressure monitoring after surgery. Perform a statistical analysis on the operative time, blood losses, postoperative drainage,postoperative intracranial pressure change in perioperation, postoperative complications and GOS by follow up after hospital discharge of the two groups.Results: 1. Perioperative Results: ① Fragmentation of the brain tissue and associated hematoma were completely cleared, and stopped bleeding under the microscope in bothgroup. ② Blood losses in the observation group were 437.83±54.18 ml, while in the control group were 746.22±259.70 ml. Operation time in the observation group was3.51±0.46 h, while in the control group was 5.35±0.28 h. Postoperative complications: 3cases of anemia, 3 cases of hypoalbuminemia and 2 cases of abnormal blood clotting happened in the observation group; 9 cases of anemia, 9 cases of hypoalbuminemia, 9cases of abnormal blood clotting, and 1 cases of wound infection and 1 cases of intracranial infection happened in the control group. There were significant differences in blood losses, operation time and postoperative complications between the two groups(t test, p<0.05), the experiment group was superior to the control group. ③Postoperative drainage of the observation group was 202.22±42.68 ml, the control group was 199.41±38.65 ml. Intracranial pressure monitoring after 1 week, the observation group was 182.53±8.68 mmH20, the control group was 182.83±8.51mmH20. There was no significant difference between the two groups compared with postoperative drainage and ICP(t test, P> 0.05).2. Follow-up results: There were 59 cases were followed up for an average time of6.41±2.09 months; 31 cases in the observation group were follow-up, the rate of favorable prognosis was 93.5%. 28 cases in the control group were follow-up, the rate of favorable prognosis was 89.3%. During follow-up, both groups with no deaths; 1case in the control group was given ventricle-peritoneal shunt for secondary hydrocephalus after the clinic visit. 5 patients in the observation group and 4 patients in the control group were given cranioplasty after 3 to 6 months post-discharge. 2 patients in the observation group and 4 patients in the control group were suffering from skull defect syndrome; 1 patient in the observation group and 2 patients in the control group appeared subdural effusion with dynamic observation.Conclusions: 1. The case-control study was the first time to used for the investing of the perioperative period and follow-up results after discharge of unilateral surgical approach to treat the patients with bilateral frontal lobe laceration in China, the results confirmed that the unilateral surgical approach can insure the treatment effects, and also reduce the complications in perioperation and rehabilitation.2. For most of asymmetric bilateral frontal lobe laceration, especially the damage foci close to the midline, the unilateral surgical approach have certain advantages.While to the bilateral frontal contusion with the back of bilateral damage foci both over the attachment plane in front of corpus callosum knee and in front of side crack,bilateral surgery approach should be taken.3. Adoption of the two groups of patients for one week of intracranial pressure monitoring after surgery, confirmed that there were no significant difference changes in intracranial pressure after surgery, that the two surgical methods both be able to effectively control intracranial pressure in the safe range.4. Good anesthetic technical support, rich theoretical and clinical experience,skilled and skilled microsurgical technique operation can reduce the surgical trauma deputy important nerves and blood vessels and other structures, thereby reducing the mortality rate and reduce complications.