Comperative study of GOS in traumatic ICH at frontal region : Between decompresion and evacuasion in department of neurosurgery ward Hasan Sadikin Hospital , Bandung from April
2009-April 2011
M Sinatrya C, M Z Arifin
Department of Neurosurgery / Faculty of Medicine Padjajaran University / Hasan Sadikin Hospital Bandung
Background : The incidence of head injury is 300 per 100,000 per year (0.3% of the population), with a mortality of 25 per 100,000. The number of patients treated for head injury in 2008 at Hasan Sadikin Hospital were respectively 889 patients for mild head injury, 432 patients for moderate head injury and 67 patients for severe head injury. A head injury may cause a ICH, which may or may not be associated with injury to the brain. Traumatic ICH have been reported in approximately 15 % of paient with fatal head injury.Traumatoic ICH are often multiple and most frequently ( in 80-90 % of cases ) occur in the white matter of the frontal and temporal.As the result of the common biomechanical mechanisms involved in their production,ICH may be assosiated with lobar contusions and the burst lobe.because ICHs typically result from rupture of intrinsic cerebral vessels ( a small parenchymal artery in most cases) they often arise from cereberal contosions.As a result, most traumatic ICHsoccur in the orbitofrontal and temporal lobes,as do more cerebral contusions.Severe headache,repeted vomiting and any impairment of the level of consciousness all suggest the need for surgical evacution of hematoma disclosed on CT in a noncomatose patient.Clinical and radiologic features suggesting raised ICP,such as obliteration of all subarachnoid CSF spaces,dilatation of the lateral ventrikel contralateral to the hematoma,occumulator paresisi ipsilateral to the a sizeable hematoma,bradycardia and arterial hypertension,all indicated an urgent need for surgical decompresion.
Methods and Design : Analysis of data obtained from a retrospective review of medical records and from a systematized database pertaining to outcame patients with ICH regio frontal that surgical therapy with decompresion and evacuation caused by head trauma treated in Neurosurgery ward Hasan Sadikin Hospital, Bandung from April 2009 – April 2011. Data was then analyzed using computerized software.
Results : We have total 19 patients diagnosed ICH at frontal region who underwent operation in department of Neurosurgery Hasan Sadikin Hospital, Bandung from April 2009-Apri 2011 . With descriptive analytic : from patients age < 25 years old, 15.8 % underwent decompersion and 31.6 % underwent evacuation. Age > 25 years old, 31.6 % underwent decompresion and 21.6 % underwent evacuation . With GCS on arrival severe head injury, 15.8 % underwent decompesion and 15.8% underwent evacuation. Moderate head injury,36.8 % underwent decompresion and 36.8% underwent evacuation. ICH with volume < 20 cc , 21.1% underwent decompresion and 10.5 % underwent evacuation. ICH with volume >20 cc, 26.3% underwent decompresion and 42.1 % underwent evacuation. Glascow outcame scale that good recovery,21.1 % underwent decompresion and 10.5 % underwent evacuation. Moderate disability, 0 % underwent decompresion and 5.3% underwent evacuation. Severe Disability,10.5% underwent decompresion and 36.6% underwent evacuation. Persistent vegetative state, 10.5% underwent decompresion and 0 % underwent evacuation. Death, 5.3% underwent decompresion and 5.3% underwent evacuation.
Discussion : Patient with parenchymal mass lesion and signs progressive neurological deterioration referable to the lesion ,medically refractory intracranial hypertension,or sign of a mass effect on CT Scan be treated operatively.Patient with a GCS score of 6 to 8 and frontal or temporal contusion larger than 20 cc in volume with midline shift of at least 5 mm or cisternal compressionon CT and pasient with any lesion larger than 50 cc in volume should be treated operatively. In our study the difference of GOS in ICH at regio frontal not significant between decompresion and evacuation. Based on the result we found that cognitive and excecutive at regio frontal, we suggest decompresion in traumatic ICH with volume 20-50cc
