Predictors of Surgical Benefit in Traumatic Frontal Lobe Contusions: A Retrospective Cohort Study with an Exploratory Severity Framework and Risk Stratification Tool

Optimal management of traumatic frontal lobe contusions remains controversial, particularly regarding patient selection for surgical intervention and the role of timing. The aim of the study is to evaluate clinical and radiological predictors associated with favorable outcomes following surgical management of traumatic frontal lobe contusions, to assess the impact of surgical timing, and to explore the development of a preliminary severity-based framework for risk stratification. This retrospective single-center study included 50 adult patients with radiologically confirmed frontal lobe contusions over a defined 4-month period. Variables analyzed included age, admission Glasgow Coma Scale (GCS), contusion volume, midline shift (MLS), treatment modality, and time to surgery. Primary outcome was favorable neurological status (Glasgow Outcome Scale [GOS] 4–5) at discharge. Comparative and multivariable analyses were performed. A total of 30 patients underwent surgery while 20 patients were managed conservatively. Surgical patients had greater baseline severity. Favorable outcomes were more frequent in the surgical group (66.7 vs. 40.0%, p = 0.06). Factors associated with improved outcomes following surgery included age <45 years, GCS <10, MLS >5 mm, and contusion volume >30 mL. Earlier surgery was associated with better outcomes, although timing definitions and subgroup heterogeneity limit definitive conclusions. An exploratory scoring framework was constructed based on variables significantly associated with outcome. However, given the limited sample size and lack of validation, this model should be considered hypothesis generating and not suitable for clinical application. Selected patients with severe frontal contusions may benefit from surgical intervention, particularly those with significant radiological mass effect and neurological impairment. Surgical timing appears to influence outcomes, but further prospective studies are required. These findings should be considered hypothesis generating.