Reduction of herniated temporal lobe in patients with severe head injury and uncal herniation

Thirty-two patients with severe head injury (Glasgow coma scale 5-7/15) and uncal herniation were treated surgically from January 1988 to June 1990. Reduction of the herniated temporal lobe in addition to classical surgical procedures (craniotomy with evacuation of hematoma and resection of the contused brain) was performed in 10 patients (group A). The remaining 22 patients (group B) were treated similarly but without reduction of the herniated temporal lobe. In group A, there was one operative mortality. Eight patients made a rapid and complete recovery of pupil size and light reflex within two days after the operation, and one recovered within two months after the operation. The recovery of motor strength was also rapid in these nine patients. After three to 20 months (average, 11 months) of follow-up, the outcome was good in two patients, and the other seven were moderately disabled. In group B, 12 patients (55%) died after the operation. When compared with group A, the surviving 10 patients made a slower and less satisfactory recovery of oculomotor nerve function and motor status, and had a worse outcome after four to 25 months (average, 14 months) of follow-up (moderately disabled, six patients; severely disabled, two patients; vegetative, two patients). From my experience, it appears that the procedure of reduction is simple and seems to result in a more rapid and complete recovery of oculomotor nerve function and motor status, and it may even contribute to a better overall outcome.