[Surgery of concussion foci in the cerebral hemispheres]

On the basis of observations in 144 patients operated on because of severe cerebral concussions, the importance of primary and secondary removal of the concussion focus is stressed. The diagnosis is made by means of EEG, angiography, and echo encephalography. Examinations of the concussion region with clearance etc. showed that the immediate vicinity of the cerebral lesion exhibits a considerably reduced blood flow which, due to the stimulus of the concussion, will further decrease within the following days. After six days, the blood supply stabilises in the zone of the oscillating reaction. The enlargement of the zone of necrosis intensifies the intracranial increase in pressure and can only be avoided by the removal of the concussion. Resection is carried out subpial in order to isolate the cerebral tissue from the dura mater. Lethality: With solitary concussion foci 22%, in case of combination with intracranial haematoma 60%, with multiple foci 67%, total 46%.