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Long-term ICP recording was carried out in 151 acute head injury patients- 131 comatose patients admitted to ICU, and 20 non-comatose patients harbouring intracerebral mass lesions (lacerations or haematomas) in whom a decision to operate was doubtful. CSF withdrawal was used in 39 cases: by intermittent subtraction in 23 patients, and by continuous ventricular drainage (VD) in the remainder. In the acute stage, within 72 hours or injury, CSF subtraction proved of little use in influencing ICP or clinical time course. Conversely, at a latter stage, CSF withdrawal either by repeated intermittent subtraction or by continuous VD could very often control raised ICP. However, some patients had to undergo permanent shunting eventually. Elevated ICP was also safely controlled in four out of eight patients with intracerebral mass lesions and stationary symptoms. Such patients recovered quickly, and operation was avoided.

On the basis of a series of 75 patients, the practical use of Icp continuous long-term recording in severe head injuries without mass lesions or remaining deeply comatose after surgical procedures is critically analyzed. ICP monitoring alone seems to be not essential for prognosis. Conversely it is of much greater use as a guide to management (respirator treatment, osmotics, CSF drainage). If the pros and cons of the procedure are carefully weighed, it would appear that, for the time being, ICP long-term monitoring is justified only in comatose patients on intensive care.

Long-term ICP monitoring was carried out in a series of 124 patients with severe head injuries admitted to the Intensive Care Unit. Forty-nine percent of patients were admitted within six hours of injury. Most of them were referred by Community Hospitals. Only patients with diffuse brain lesions or patients operated on for mass lesions and remaining in a coma state after operation are taken into account. Altogether, 46 patients survived, but 15 of them remained severely disabled or in a vegetative state, and 78 died. Twenty-four percent of the whole series succumbed to fulminationg intracranial hypertension. The average survival in this group was 5.1 days. Twenty-nine percent died after exhibiting different levels of intracranial hypertension ranging from 20 to 50 mm Hg. In this group the role of extracerebral complications as a cause of death should not be underestimated. Death caused by cerebral lesions with ICP not exceeding 15 mm Hg was exceedingly rare in the first 72 hours. Normal or fairly raised ICP does not rule out the risk of devastating intracranial hypertension: reliable and harmless P/V tests are needed. All patients who survived after showing sustained intracranial hypertension exceeding 50 mm Hg were under 20 years of age. In the present series the results of treatment of intracranial hypertension were, on the whole, rather disappointing.

Contusions and lacerations of the frontal lobes are very frequent; 43.4% in the whole series of traumatic brain mass lesions. Clinical ICP, CT scan data and neuropathological findings in patients with such lesions are analysed and correlated. Moreover, the clinical features and the outcome of frontal masses undergoing surgery are also compared with similar lesions located in the temporal lobes. Frontal lesions cannot be differentiated on purely clinical grounds and the factors governing the outcome in both lactations are the same. On the whole, surgical indications nowadays seem to be rather rare; only lesions behaving truly as expanding lesions with obvious intracranial hypertension benefiting from surgery. Brain contusion-laceration syndromes in general can no longer be considered separate entities. Neither should they be included in the miscellaneous group of "traumatic intracranial mass lesions", since the pathophysiological significance of purely extracerebral effusions is entirely different. Traumatic contusions and lacerations and/or intracerebral haematomas, whether frontal or located elsewhere, should instead, be considered in the context of head injuries of a different degree of gravity, as having collateral features which, on occasion, may call for surgical management.

The accuracy of CAT in the diagnosis of infratentorial expanding lesions is analysed on the basis of 224 personal cases. The posterior fossa lesions are classified in four groups according to the reliability of CAT as the only pre-operative examination. The present indications for conventional neuroadiological procedures are also outlined. Particular emphasis is laid on the information supplied by CAT in postoperative follow up to detect both immediate and delayed complications.