Abstract Management of traumatic bifrontal (BF) contusions is unique and challenging, as the decisions vary significantly among neurosurgeons due to the complexity of the condition. Points of controversy in management include medical versus surgical management, craniotomy versus decompressive craniectomy (DC), evacuation versus no evacuation of contusions. This is a retrospective study conducted at a tertiary care center between January 2016 and January 2023. Patients with BF contusions were selected for the study. Various treatment modalities (type of surgery or medical therapy or both) were compared with the Glasgow Outcome Scale-Extended (GOSE) as an outcome measure. A total of 54 patients with BF contusions were included. Males were 63% (n = 34) and females were 37% (n = 20). Median (interquartile range IQR) BF contusion volume was 39.5 mL (26.7–56 mL). Bilateral symmetric contusions were noted in 9 (16.6%) patients. Left side contusions were larger in 30 (55.6%) patients, and right side contusions were larger in 15 (27.8%) patients. Of 54 patients, 48 patients underwent surgical management. DC was done in 28 of 48 patients. Twenty (41.6%) patients underwent craniotomy and evacuation of contusion. Median (IQR) length of follow-up was 31.3 (11.5, 44.3) months. Median GOSE score (IQR) was 6 (4.3–7). Favorable outcome (GOSE >4) was seen in 51.8% patients. Mortality rate was 46.3%, median duration of survival in these patients after surgery was 4.3 (1–12.9) weeks. Older age, low Glasgow Coma Scale at presentation, and DC were associated with poor outcome and higher mortality. Patients who underwent craniotomy and evacuation of contusions had better outcome as compared with patients who underwent DC. Patients with bilateral involvement and left side involvement had a higher proportion of bedbound status. Patients with right-sided involvement had higher chances of performing activities of daily living (ADL) adequately. To conclude, craniotomy with evacuation of contusions had better outcome as compared with DC with evacuation of contusions.
Gupta et al. (Wed,) studied this question.