Abstract
Background
The optimal management strategy for cerebral contusion remains controversial, especially when standard craniotomy could not be used. We performed neuro-endoscopic target lesionectomy for the delayed progression of cerebral contusion in order to aspirate the necrotic core, which is the primal source of contusional edema.
Methods
The present study included 10 consecutive patients (2 women and 8 men, with a mean age of 67 years old) with traumatic brain injury presenting with delayed deterioration of cerebral contusion where standard craniotomy could not be used. Neuro-endoscopic aspiration of the necrotic core was prospectively performed for all patients. We assessed the computed tomography findings after surgery to evaluate the efficacy of this procedure.
Results
Endoscopic surgery was performed promptly after neurological deterioration, with a mean interval between trauma and surgery of 7 days, ranging from 2 to 16 days. During the operation, the centers of contusions comprised serous liquid components in all 10 patients and were easily aspirated by endoscopy. Contusional edemas were markedly decreased in all within 3 days after surgery.
Conclusions
Progression of contusional edema can be caused by the accumulation of water into the necrotic core due to the rapid increase in osmolality. In light of the highly liquefied demarcated characteristics of the necrotic core, neuro-endoscopic aspiration could be an optional treatment strategy for cerebral contusion with delayed progression in a minimally invasive manner.
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References
Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters B, Wilberger J (2006) Surgical management of traumatic parenchymal lesions. Neurosurgery 58:S25–S46
Katayama Y, Tsubokawa T, Kinoshita K, Himi K (1992) Intraparenchymal blood-fluid levels in traumatic intracerebral haematomas. Neuroradiology 34:381–383
Katayama Y, Mori T, Maeda T, Kawamata T (1998) Pathogenesis of the mass effect of cerebral contusions: rapid increase in osmolality within the contusion necrosis. Acta Neurochir Suppl 71:289–292
Kawamata T, Katayama Y (2006) Surgical management of early massive edema caused by cerebral contusion in head trauma patients. Acta Neurochir Suppl 96:3–6
Kawamata T, Katayama Y (2007) Cerebral contusion: a role model for lesion progression. Prog Brain Res 161:161–235
Kuo JR, Lin KC, Lu CL, Lin HJ, Wang CC, Chang CH (2004) Coagulopathy as a parameter to predict the outcome in head injury patients–analysis of 61 cases. J Clin Neurosci 11:710–714
Lindenberg R, Freytag E (1960) The mechanism of cerebral contusion. Arch Pathol 69:440–469
Shima K, Aruga T, Onuma T, Shigemori M (2010) JSNT-guidelines for the Management of Severe Head Injury (abridged edition). Asian J Neurosurg 5:15–23
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The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in this study were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Informed consent
Informed consent was obtained from individual participants included in the study, when the patient was alert and had enough understanding. When the patient was in coma, informed consent was obtained from her/his families.
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This article is part of the Topical Collection on Brain Trauma
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Mino, M., Fujimura, M., Yoshida, M. et al. Application of neuro-endoscopic target aspiration of the necrotic core for cerebral contusion with delayed progression: technical note. Acta Neurochir 161, 225–230 (2019). https://doi.org/10.1007/s00701-018-3753-z
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DOI: https://doi.org/10.1007/s00701-018-3753-z