What question did this study set out to answer?

The aim is to assess the management strategies for bifrontal contusions and their outcomes.

July 10, 2026Open Access

Original ArticleManagement of Bifrontal Contusions: Revisited

RGRahul GuptaNational Institute of Mental Health and Neurosciences GPGugamsetti Sai PhaneendraNational Institute of Mental Health and Neurosciences CJChirag JainMax Healthcare

Key Points

The aim is to assess the management strategies for bifrontal contusions and their outcomes.
Retrospective study at a tertiary care center from January 2016 to January 2023.
Included 54 patients with bifrontal contusions, comparing surgical and medical management using the Glasgow Outcome Scale-Extended.
Evaluated different surgical approaches: craniotomy versus decompressive craniectomy for treatment outcomes.
Favorable outcome (GOSE >4) in 51.8% of patients; median GOSE score was 6 (IQR 4.3–7).
Mortality rate was 46.3%, with median survival duration of 4.3 weeks post-surgery.
Craniotomy with evacuation resulted in better outcomes compared to decompressive craniectomy.

Abstract

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.

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