Traumatic cerebral mass lesions: correlations between clinical, intracranial pressure, and computed tomographic data

After surveying the different phases of their previous experience with the diagnosis and management of traumatic cerebral mass lesions, the authors analyze the correlation between clinical, computed tomographic (CT), and intracranial pressure (ICP) data in 29 patients with traumatic intracerebral hematomas and/or brain lacerations. Clinically, the patients are classified in three groups: (a) deeply comatose patients (Glascow coma scale (GCS), 4 to 5); (b) patients with intermediate disturbances of consciousness (GCS, 6 to 10); and (c) patients with minor impairment of consciousness (GCS, more than 10). Sixteen patients were operated upon. Operation was ineffective in the patients who were already deeply comatose in the first hours after injury, even though elevated ICP was definitely reduced after operation in some of them. Conversely, patients with well-limited lesions, moderate disorders of consciousness, and persisting intracranial hypertension despite medical therapy seemed to be good candidates for delayed operation by limited procedures. In patients with intermediate disturbances of consciousness and no tendency to improvement or deterioration, ICP monitoring correlated with CT scan appearance may be of practical use for making the decision to operate. However, most cases diagnosed on CT scan have a benign course; the patients recover uneventfully with conservative management. In such patients careful clinical observation is usually sufficient. (Neurosurgery, 7: 337-346, 1980).