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BACKGROUND Dissymmetric bilateral frontal contusion (DBFC) is relatively frequent in the clinic. In this study, we aimed to investigate the development tendency, clinical features, and treatment experience of DBFC and to summarize out experience in treating these patients via minimally invasive means-endoscopy. METHODS Over the past 3 years, we have treated a total of 31 patients with DBFC using endoscopy-assisted unilateral cerebral falx incision. We used a 30-degree endoscope to observe the involvement of brain contusion and whether the brain contusions have been cleaned thoroughly. Another 30 patients treated by routine bilateral approach within the same period were taken as controls. RESULTS Seventeen cases (54.8%) in the unilateral-operation group survived and were in good condition, 8 cases (25.8%) had moderate disability, and 4 cases (12.9%) had severe disability; 1 case (3.2%) was in vegetable state, and 1 case (3.2%) died. Compared with the control group, the GOS score was not significantly different in the unilateral-operation group, but the operation time, blood transfusion volume, length of hospital stay, incidence of mental disorder, and incidence of olfactory nerve injury were greatly reduced in the unilateral-operation group. CONCLUSIONS Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time and reduce surgical trauma and complications when used for treatment of patients with DBFC.

ObjectiveTo study the effect and indications of intracranial pressure (ICP) monitoring for frontal lobe contusion patients.MethodsDuring January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department (monitoring group). Different treatment protocols were adopted according to the results of ICP. Meanwhile 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group.ResultsWe found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases (70.6%), moderate disability in 7 cases (20.6%), severe disability in 2 (5.88%) and death in 1 (2.94%). The outcome of control group displayed good condition in 25 cases (54.3%), moderate disabilities in 8 (17.4%), severe disability in 7 (15.2%), and death in 6 (13.0%).ConclusionsFrontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. If ICP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.