Commentary 5.1.1.

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Specific indications for intracranial traumatic leasons operation

Jaroslav Plas

European Brain Injury Consortium (EBIC)1 covers among specific indications for operations of intracranial traumatic leasons as follows:

a)     clinical deterioration of the patient´s state,
b)     more than 1 cm thick extracerebral clot, more than 25-30 ml intracerebral haematoma,
c)      midline shift farther than 5 mm on CT,
d)     enlargement of contralateral ventricle (temporal horn),
e)     obliteration of basal cisterns/third ventricle,
f)        raised or increasing ICP.

To point c) it is to be made accurate that it is necessary to evaluate not the displacement of the midline, but the displacement of third ventricle2. To point e) it is necessary to evaluate obliteration of cisterna laminae quadrigemine (so-called cisterna perimesencephalica).

References:

1.      Maas AIR, Dearden M, Teasdale GM, et al: EBIC-Guidelines for management of severe head injury in adults. Acta Neurochir(Wien) 1997;139:286-294.

2.      Greenberg MS: Head trauma. In Greenberg MS: Handbook of Neurosurgery. 3rd ed, Lakeland, Florida:Greenberg Graphics  Inc,1994:521-569.

 

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Last updated: 2000-08-04