[Surgical tactics in contusions of the cerebral hemispheres]

The author conducted complex examination of 540 patients who were operated on for brain contusion. Comparison of the clinical and instrumental findings with the pathomorphological changes in the brain (disclosed during operation or autopsy) revealed the structural features of contusion foci of convex and pole-basal localization which were factors underlying the three-dimensional enlargement of the affected brain lobe in cases of increasing perifocal edema. The results of surgical management were analysed according to the character of the contusion foci, the extent of traumatic softening of the white matter in the zone of the contusion, and the volume of surgical debridement of the foci. It is concluded that decompression of the brain can be accomplished by removing massive convex and pole-basal contusion foci penetrating the deep layers of the cerebral hemispheres; the volume of surgical debridement of contusion foci is determined by their macrostructure and the size of the zone of white matter softening.