Why mortality is still high with modern care of 613 evacuated mass lesions presented as severe head injuries 1999-2009

Leon Levi, Joseph Guilburd, Jean Soustiel, Gill Sviri, Marius Constantinescu, Menashe Zaaroor

Research output: Chapter in Book/Report/Conference proceedingConference contribution

1 Scopus citations


Of 1,949 successive acute severe head injuries (SHI) over a period of 11 years 1999-2009, 613 (31.5%) underwent evacuation of mass lesions. Mortality at 3 months of evacuated mass (EM) lesions was higher over 10 years compared with that of non-EM lesions (it was overall 22%). The reduction of mortality was significantly less in EM compared with that for non-surgical cases (14.4-9.4% recently) and for the cases that were operated but not for mass evacuation (18.1-12.1%). A few explanations are: first, more SDH (60.5% of the EM recently compared with 45.9% in the first few years); second, more severe cases and older patients with co-morbidities were treated surgically; third, advances in prehospital care brought more severe patients to operative care-the rate of referrals decreased from 61.5% to 52.8% recently; fourth, part of the significant shortening of the injury to NT admission time (163-141 min) vanished owing to the parallel elongation of admission to operation time (95-100 min), thus, the threshold recommendation of 4 h to mass evacuation was achieved in only 52%; fifth, introducing decompressive craniectomy was not associated with outcome improvement.

Original languageEnglish (US)
Title of host publicationIntracranial Pressure and Brain Monitoring XIV
PublisherSpringer-Verlag Wien
Number of pages4
ISBN (Print)9783709109557
StatePublished - 2012

Publication series

NameActa Neurochirurgica, Supplementum
ISSN (Print)0065-1419
ISSN (Electronic)0001-6268


  • Evacuated mass lesion
  • Neurotrauma
  • Regional trauma care
  • Severe head injury, outcome

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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