Published in:
01-01-2015 | Neurological Update
What’s new in the surgical management of traumatic brain injury?
Published in: Journal of Neurology | Issue 1/2015
Login to get accessExcerpt
Traumatic brain injury (TBI) remains the commonest cause of death and disability amongst people under the age of 40. Advances in neuro-imaging and neuro-intensive care during the 1980s and 1990s, improved pre-hospital care and the development of major trauma centres in more recent years, have all contributed to the provision of better care and improved outcomes for head-injured patients [1]. Here we explore the latest developments in the surgical management of TBI (Table 1).
Table 1
The rationale of surgical interventions for TBI
|
Intervention
|
Rationale
|
|---|---|
|
Evacuation of intracranial haematomas
|
Reduction of mass effect on the underlying brain and/or brainstem
|
|
Decompressive craniectomy
|
Intracranial compliance improves and ICP is reduced
|
|
External ventricular drainage
|
Intracranial compliance improves and ICP is reduced
|
|
Surgery for depressed skull fractures
|
Debridement reduces the risk of intracranial infection; elevation/reconstruction improves cosmesis
|
|
Surgery for post-traumatic CSF leaks
|
Repair reduces the risk of ascending intracranial infection
|
|
Insertion of ventriculo-peritoneal shunt
|
Diversion of CSF improves symptoms associated with hydrocephalus
|
|
Cranioplasty
|
Cranial reconstruction restores skull contour and protects underlying brain
|