Cerebral contusion: a role model for lesion progression.

The early massive edema caused by severe cerebral contusion results in progressive intracranial pressure (ICP) elevation and clinical deterioration within 24-72 h post-trauma. Surgical excision of the necrotic brain tissue represents the only therapy, which can provide satisfactory control of the elevated ICP and clinical deterioration. In this chapter, we review the results of our clinical studies regarding the pathophysiology of contusion edema and evaluate the effects of surgical treatment, i.e. contusion necrotomy, by analyzing the data from the Japan Neurotrauma Data Bank.