[Technic for surgical intervention in severe brain contusions and crushing]

Basal contusions of the frontal and temporal lobes of the brain, occurring as a contrecoup as a rule, are particularly severe and are marked by a high mortality. The 10-year practice of the Sklifosovsky Scientific Research Institute of Emergency Aid in the surgical management of cerebral contusion was aimed at the search for a less traumatic craniotomy approach and the most sparing and radical, within reasonable limits, intervention on the cerebral focus. Analysis of the work done enables us to choose the method described in the article, comprising extensive infratemporal craniotomy which excludes the frontal, temporal, and parietal, lobes, and to recommend combining intervention on the focus with internal decompression and active aspiration of the wound discharge from the cranial cavity in the first 24 hours after the operation. The illustrations supplied show the stages of the operation: linear skin incision, incision and separation of the temporal muscle, resection of the squama of the temporal and frontal bones down to the base of the skull. The operation may also be carried out as osteoplasty (sites for forming the trephination openings are shown in Fig. 1, a).