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On-line version ISSN 1678-4227
Arq. Neuro-Psiquiatr. vol.56 n.4 São Paulo Dec. 1998
POST-TRAUMATIC TEMPORAL LOBE LESIONS: NATURAL HISTORY AND TREATMENT (ABSTRACT)*. THESIS. SÃO PAULO, 1997.
ALEXANDRE VARELLA GIANNETTI **
This is a prospective study of 69 patients with traumatic temporal lobe lesions (TTLL). Computerized tomography (CT) scans were performed in the first 36 hours, 7 and 30 days after the trauma. Lesions were classified into anterior, posterior and anterior-posterior in relation to a coronal plane immediately anterior to the cerebral peduncles. The investigation aimed to assess the natural history and to identify criteria for indication of surgical treatment of these lesions.
Forty patients with the first CT scan performed within 12 hours after trauma were selected for study of the natural history of TTLL. Hyperdensity (hemorrhage) enlarged in 35% of studied subjects. Interval between trauma and initial care at the emergency room of three hours or less predicted increase in hemorrhage. Age, accident speed, alcohol abuse, coagulation changes, and presence of decompressing factors were not statistically related to enlargement of hyperdensity. These findings are consistent with the development of several foci of hemorrhage at the trauma with subsequently enlarge and merge. There was increase of hypodensity (necrosis and edema) in half of studied subjects, 36 hours and seven days after trauma. There was no relationship between these findings, evolution or size of the hemorrhage as well as its surgical treatment.
Conservative treatment of the patients was related to the presence of one or absence of all of the following parameters on CT scan: shift of midline structures, change of aspect of ventricles, cisterns and sulci. Patients displaying all of them required surgical drainage. Among the operated lesions, there was an inverse relationship between the size of transverse diameter and anterior location (i.e., the more anterior the operated lesion, the smaller its diameter).
KEY WORDS: head injury, temporal lobe lesions, CT scan, neurosurgery.
*Lesões traumáticas do lobo temporal: evolução natural e tratamento (Resumo). Tese de Mestrado, Escola Paulista de Medicina ¾ Universidade Federal de São Paulo, UNIFESP (Área: Neurocirurgia). Orientador: Mirto Nelso Prandini.
**Address: Rua Agripa Vasconcelos 230, 30210-030 Belo Horizonte MG, Brasil.