Comperative study of GOS in traumatic ICH at frontal region : Between decompresion and evacuasion in department of neurosurgery ward Hasan Sadikin Hospital , Bandung from April 2009-April 2011.
Comperative study of GOS in traumatic ICH at frontal region : Between decompresion and
evacuasion in department of neurosurgery ward Hasan Sadikin Hospital , Bandung from April
2009-April 2011
M Sinatrya C, M Z Arifin
Department of Neurosurgery / Faculty of Medicine Padjajaran University / Hasan Sadikin Hospital
Bandung
Background : The incidence of head injury is 300 per 100,000 per year (0.3% of the
population), with a mortality of 25 per 100,000. The number of patients treated for head injury in
2008 at Hasan Sadikin Hospital were respectively 889 patients for mild head injury, 432 patients for
moderate head injury and 67 patients for severe head injury. A head injury may cause a ICH, which
may or may not be associated with injury to the brain. Traumatic ICH have been reported in
approximately 15 % of paient with fatal head injury.Traumatoic ICH are often multiple and most
frequently ( in 80-90 % of cases ) occur in the white matter of the frontal and temporal.As the result of
the common biomechanical mechanisms involved in their production,ICH may be assosiated with
lobar contusions and the burst lobe.because ICHs typically result from rupture of intrinsic cerebral
vessels ( a small parenchymal artery in most cases) they often arise from cereberal contosions.As a
result, most traumatic ICHsoccur in the orbitofrontal and temporal lobes,as do more cerebral
contusions.Severe headache,repeted vomiting and any impairment of the level of consciousness all
suggest the need for surgical evacution of hematoma disclosed on CT in a noncomatose
patient.Clinical and radiologic features suggesting raised ICP,such as obliteration of all subarachnoid
CSF spaces,dilatation of the lateral ventrikel contralateral to the hematoma,occumulator paresisi
ipsilateral to the a sizeable hematoma,bradycardia and arterial hypertension,all indicated an urgent
need for surgical decompresion.
Methods and Design : Analysis of data obtained from a retrospective review of medical
records and from a systematized database pertaining to outcame patients with ICH regio frontal that
surgical therapy with decompresion and evacuation caused by head trauma treated in Neurosurgery
ward Hasan Sadikin Hospital, Bandung from April 2009 – April 2011. Data was then analyzed using
computerized software.
Results : We have total 19 patients diagnosed ICH at frontal region who underwent
operation in department of Neurosurgery Hasan Sadikin Hospital, Bandung from April 2009-Apri
2011 . With descriptive analytic : from patients age < 25 years old, 15.8 % underwent decompersion
and 31.6 % underwent evacuation. Age > 25 years old, 31.6 % underwent decompresion and 21.6 %
underwent evacuation . With GCS on arrival severe head injury, 15.8 % underwent decompesion and
15.8% underwent evacuation. Moderate head injury,36.8 % underwent decompresion and 36.8%
underwent evacuation. ICH with volume < 20 cc , 21.1% underwent decompresion and 10.5 %
underwent evacuation. ICH with volume >20 cc, 26.3% underwent decompresion and 42.1 %
underwent evacuation. Glascow outcame scale that good recovery,21.1 % underwent decompresion
and 10.5 % underwent evacuation. Moderate disability, 0 % underwent decompresion and 5.3%
underwent evacuation. Severe Disability,10.5% underwent decompresion and 36.6% underwent
evacuation. Persistent vegetative state, 10.5% underwent decompresion and 0 % underwent
evacuation. Death, 5.3% underwent decompresion and 5.3% underwent evacuation.
We chose analysis using independent samples chi-squares : there’s a not significant difference (
p=0.245 ) between groups of age < 25 years old and age >25 years old that underwent decompresion
and evacuation. The difference of GCS also not significant ( p= 0.876 %) between groups severe head
injury and moderate head injury that underwent decompresion and evacuation. The difference of ICH
wasn’t significant (p=0,252) between ICH with volume 20cc that underwent
decompresion and evacuation. Comparation between decomperation and evacuation in GOS is not
siginificant difference( p=0.229).
Discussion : Patient with parenchymal mass lesion and signs progressive neurological
deterioration referable to the lesion ,medically refractory intracranial hypertension,or sign of a mass
effect on CT Scan be treated operatively.Patient with a GCS score of 6 to 8 and frontal or temporal
contusion larger than 20 cc in volume with midline shift of at least 5 mm or cisternal compressionon
CT and pasient with any lesion larger than 50 cc in volume should be treated operatively. In our study
the difference of GOS in ICH at regio frontal not significant between decompresion and evacuation.
Based on the result we found that cognitive and excecutive at regio frontal, we suggest decompresion
in traumatic ICH with volume 20-50cc
Concclusion : there’s a not significant difference of GOS that underwent decompresion and
evacuation in traumatic ICH with volume 15-50 cc. We need more samples and prospective study for
an accurate result.
evacuasion in department of neurosurgery ward Hasan Sadikin Hospital , Bandung from April
2009-April 2011
M Sinatrya C, M Z Arifin
Department of Neurosurgery / Faculty of Medicine Padjajaran University / Hasan Sadikin Hospital
Bandung
Background : The incidence of head injury is 300 per 100,000 per year (0.3% of the
population), with a mortality of 25 per 100,000. The number of patients treated for head injury in
2008 at Hasan Sadikin Hospital were respectively 889 patients for mild head injury, 432 patients for
moderate head injury and 67 patients for severe head injury. A head injury may cause a ICH, which
may or may not be associated with injury to the brain. Traumatic ICH have been reported in
approximately 15 % of paient with fatal head injury.Traumatoic ICH are often multiple and most
frequently ( in 80-90 % of cases ) occur in the white matter of the frontal and temporal.As the result of
the common biomechanical mechanisms involved in their production,ICH may be assosiated with
lobar contusions and the burst lobe.because ICHs typically result from rupture of intrinsic cerebral
vessels ( a small parenchymal artery in most cases) they often arise from cereberal contosions.As a
result, most traumatic ICHsoccur in the orbitofrontal and temporal lobes,as do more cerebral
contusions.Severe headache,repeted vomiting and any impairment of the level of consciousness all
suggest the need for surgical evacution of hematoma disclosed on CT in a noncomatose
patient.Clinical and radiologic features suggesting raised ICP,such as obliteration of all subarachnoid
CSF spaces,dilatation of the lateral ventrikel contralateral to the hematoma,occumulator paresisi
ipsilateral to the a sizeable hematoma,bradycardia and arterial hypertension,all indicated an urgent
need for surgical decompresion.
Methods and Design : Analysis of data obtained from a retrospective review of medical
records and from a systematized database pertaining to outcame patients with ICH regio frontal that
surgical therapy with decompresion and evacuation caused by head trauma treated in Neurosurgery
ward Hasan Sadikin Hospital, Bandung from April 2009 – April 2011. Data was then analyzed using
computerized software.
Results : We have total 19 patients diagnosed ICH at frontal region who underwent
operation in department of Neurosurgery Hasan Sadikin Hospital, Bandung from April 2009-Apri
2011 . With descriptive analytic : from patients age < 25 years old, 15.8 % underwent decompersion
and 31.6 % underwent evacuation. Age > 25 years old, 31.6 % underwent decompresion and 21.6 %
underwent evacuation . With GCS on arrival severe head injury, 15.8 % underwent decompesion and
15.8% underwent evacuation. Moderate head injury,36.8 % underwent decompresion and 36.8%
underwent evacuation. ICH with volume < 20 cc , 21.1% underwent decompresion and 10.5 %
underwent evacuation. ICH with volume >20 cc, 26.3% underwent decompresion and 42.1 %
underwent evacuation. Glascow outcame scale that good recovery,21.1 % underwent decompresion
and 10.5 % underwent evacuation. Moderate disability, 0 % underwent decompresion and 5.3%
underwent evacuation. Severe Disability,10.5% underwent decompresion and 36.6% underwent
evacuation. Persistent vegetative state, 10.5% underwent decompresion and 0 % underwent
evacuation. Death, 5.3% underwent decompresion and 5.3% underwent evacuation.
We chose analysis using independent samples chi-squares : there’s a not significant difference (
p=0.245 ) between groups of age < 25 years old and age >25 years old that underwent decompresion
and evacuation. The difference of GCS also not significant ( p= 0.876 %) between groups severe head
injury and moderate head injury that underwent decompresion and evacuation. The difference of ICH
wasn’t significant (p=0,252) between ICH with volume 20cc that underwent
decompresion and evacuation. Comparation between decomperation and evacuation in GOS is not
siginificant difference( p=0.229).
Discussion : Patient with parenchymal mass lesion and signs progressive neurological
deterioration referable to the lesion ,medically refractory intracranial hypertension,or sign of a mass
effect on CT Scan be treated operatively.Patient with a GCS score of 6 to 8 and frontal or temporal
contusion larger than 20 cc in volume with midline shift of at least 5 mm or cisternal compressionon
CT and pasient with any lesion larger than 50 cc in volume should be treated operatively. In our study
the difference of GOS in ICH at regio frontal not significant between decompresion and evacuation.
Based on the result we found that cognitive and excecutive at regio frontal, we suggest decompresion
in traumatic ICH with volume 20-50cc
Concclusion : there’s a not significant difference of GOS that underwent decompresion and
evacuation in traumatic ICH with volume 15-50 cc. We need more samples and prospective study for
an accurate result.