THE USE OF LOBECTOMY IN THE MANAGEMENT OF SEVERE CLOSED-HEAD TRAUMA

A RETROSPECTIVE REVIEW is presented of 20 patients with traumatic brai n injury who were treated during the course of their illness by lobect omies either after a herniation or other significant deterioration or to reduce elevated intracranial pressure. All the patients suffered fr om blunt head trauma. Patient ages ranged from 19 to 59 years (average , 34 yr). The initial Glasgow Coma Scale score ranged from 3 to 15 (av erage, 8.2). There were 14 frontal lobectomies, 2 temporal, 3 frontal and temporal, and 1 occipital. Surgery was performed between 0 and 8 d ays after injury (average, 2.8). Outcome was favorable (good or modera tely disabled) in 11 patients and unfavorable (severely disabled, pers istently vegetative, or dead) in 9. No patients survived in a persiste ntly vegetative state. A higher initial Glasgow Coma Scale score was p ositively correlated with a more favorable outcome (P < 0.03). Younger patients also showed a significant positive relationship to outcome ( P < 0.0005). Better pupillary reactivity showed a significant trend to ward a more favorable outcome (P < 0.04). The type of lesions identifi ed on computed tomographic scans had no association with outcome. A lo bectomy can be a useful adjuvant in the management of severe brain inj ury, especially in younger patients with relatively higher initial Gla sgow Coma Scale scores who subsequently deteriorate or develop elevate d intracranial pressure.