The Role of Surgical Intervention in Traumatic Brain Injury

Adams, Hadie; Kolias, Angelos G.; Hutchinson, Peter J.

doi:10.1016/j.nec.2016.05.007

Cited by 19 publications

(13 citation statements)

References 105 publications

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“…Therefore, we recommend the use of a less strict definition of the indications for surgery in order to improve the treatment success rate in patients with BFCs. Traditional guidelines suggest that surgical treatment should be performed immediately if the following signs are present in patients with traumatic brain injuries: contused volume of the frontal, temporal, or parietal lobes > 20 mL and a midline shift > 5 mm with basal cistern compression [ 7 ]. We suggested that surgical treatment is indicated if (1) conscious patients experience mild disturbances of consciousness and restlessness, miosis, slow pupillary light reflex, increased blood pressure, faster pulse and respiration, and increased muscle tone; (2) dynamic CT monitoring shows a trend toward increased primary and scattered contusion spots or significantly expanded edema and compression of the frontal horn of the lateral ventricle; and (3) significant enlargement of unilateral contusions, or intracerebral hematoma and a > 5 mm shift of the anterior midline to the contralateral side, which could be accompanied by decreased consciousness.…”

Section: Discussionmentioning

confidence: 99%

Clinical application of the supraorbital key-hole approach to the treatment of unilateral-dominant bilateral frontal contusions

et al. 2017

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We compared the surgical efficacy of the supraorbital key-hole approach (SKA) to conventional unilateral frontotemporal craniotomy (UFTC) for the treatment of patients with unilateral-dominant bilateral frontal contusions (BFCs). A retrospective analysis of 62 patients with unilateral-dominant BFCs who underwent surgery at our institute between 2014 and 2017 was performed. There were 26 patients who underwent SKA (group A) and 36 who underwent UFTC (group B). Postoperative computed tomography scans showed satisfactory evacuation of the frontal cerebral contusions in both groups (p > 0.05). There was less intraoperative blood loss in group A than group B (17.1 ± 4.55 vs. 67.6 ± 10.28 mL, p < 0.05). The operative time was also shorter in group A (82.7 ± 13.73 vs. 132.4 ± 9.17 min, p < 0.05). Postoperative bleeding occurred in three cases in group A and in only one case in group B (p > 0.05). The average length of hospitalization was shorter in group A than group B (7.3 ± 1.09 vs. 12.9 ± 1.71 days, p < 0.05). No differences in the Glasgow Outcome Scale were observed between the two groups after 6 months of follow-up (p > 0.05). Thus, compared to UFTC, SKA is associated with shorter operation times and less trauma to the surrounding brain tissue.

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Section: Discussionmentioning

confidence: 99%

Clinical application of the supraorbital key-hole approach to the treatment of unilateral-dominant bilateral frontal contusions

et al. 2017

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“…EDH requires urgent neurosurgical evacuation. With prompt intervention, prior to herniation or local compression, the outcome from an EDH may be good, as there is often little underlying neuronal damage compared to subdural hematomas (SDHs), which often have associated direct parenchymal injury and edema …”

Section: Mechanisms and Complications Of Injurymentioning

confidence: 99%

Management of moderate and severe traumatic brain injury

2019

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Traumatic brain injury (TBI) is a common disorder with high morbidity and mortality, accounting for one in every three deaths due to injury. Older adults are especially vulnerable. They have the highest rates of TBI‐related hospitalization and death. There are about 2.5 to 6.5 million US citizens living with TBI‐related disabilities. The cost of care is very high. Aside from prevention, little can be done for the initial primary injury of neurotrauma. The tissue damage incurred directly from the inciting event, for example, a blow to the head or bullet penetration, is largely complete by the time medical care can be instituted. However, this event will give rise to secondary injury, which consists of a cascade of changes on a cellular and molecular level, including cellular swelling, loss of membrane gradients, influx of immune and inflammatory mediators, excitotoxic transmitter release, and changes in calcium dynamics. Clinicians can intercede with interventions to improve outcome in the mitigating secondary injury. The fundamental concepts in critical care management of moderate and severe TBI focus on alleviating intracranial pressure and avoiding hypotension and hypoxia. In addition to these important considerations, mechanical ventilation, appropriate transfusion of blood products, management of paroxysmal sympathetic hyperactivity, using nutrition as a therapy, and, of course, venous thromboembolism and seizure prevention are all essential in the management of moderate to severe TBI patients. These concepts will be reviewed using the recent 2016 Brain Trauma Foundation Guidelines to discuss best practices and identify future research priorities.

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“…[ 1 ] Surgical decompressive craniectomy (DC) is recommended in such cases, intervention being aimed at lowering ICP to minimize secondary brain damage. [ 2 3 ]…”

Section: Introductionmentioning

confidence: 99%

Outcome of decompressive craniectomy in traumatic closed head injury

et al. 2018

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Objective:The aim of the current study was to observe functional outcomes of patients undergoing decompressive craniectomy (DC) for raised intracranial pressure (ICP) after blunt head injury and to assess possible predictive factors.Methodology:This study was a prospective cohort study which was conducted at Aga Khan University Hospital, Karachi over a period of 2 years (January 2015–December 2016). Adult patients, aged between 15 and 65 years of both genders undergoing DC during the study period were selected. Outcomes of DC were assessed at an interval of 3 months following injury using the Glasgow outcome score. The data were analyzed on IBM statistics SPSS version 21.Results:Seventy-two patients underwent DC for raised and refractory ICP. Glasgow Outcome Scale (GOS) at discharge, 1-month and 3-month follow-up were reported. GOS at 3-month follow-up showed 21 patients (29.2%) patients had a good recovery, moderate disability was reported in 16 patients (22.2%), and severe disability in 12 patients (16.7%), persistent vegetative state was seen in five patients (6.9%). Eighteen patients had in hospital mortality (25.0%). Tracheostomy and sphenoid fractures were found to be negative predictors of good functional outcome.Conclusions:DC is associated with an in hospital mortality of 25.0%. Favorable outcomes were seen in 51.4% patients. Tracheostomy and sphenoid fractures were negative predictors of good functional outcome. The results are comparable to international literature.

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The Role of Surgical Intervention in Traumatic Brain Injury

Cited by 19 publications

References 105 publications

Clinical application of the supraorbital key-hole approach to the treatment of unilateral-dominant bilateral frontal contusions

Clinical application of the supraorbital key-hole approach to the treatment of unilateral-dominant bilateral frontal contusions

Management of moderate and severe traumatic brain injury

Outcome of decompressive craniectomy in traumatic closed head injury

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