Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-02T20:24:13.094Z Has data issue: false hasContentIssue false

Chapter 17 - Surgical Issues in the Management of Head-Injured Patients

Published online by Cambridge University Press:  28 April 2020

By
Jane Halliday ,
Peter C. Whitfield  and
Puneet Plaha
Edited by
Peter C. Whitfield ,
Jessie Welbourne ,
Elfyn Thomas ,
Fiona Summers ,
Maggie Whyte  and
Peter J. Hutchinson
Peter C. Whitfield
Affiliation:
Derriford Hospital, Plymouth
Jessie Welbourne
Affiliation:
University Hospitals, Plymouth
Elfyn Thomas
Affiliation:
Derriford Hospital, Plymouth
Fiona Summers
Affiliation:
Aberdeen Royal Infirmary
Maggie Whyte
Affiliation:
Aberdeen Royal Infirmary
Peter J. Hutchinson
Affiliation:
Addenbrooke’s Hospital, Cambridge
Get access

Summary

This chapter reviews the indications for surgical intervention and operative nuances that may facilitate neurosurgical procedures. We discuss the surgical management of patients with traumatic intracranial haematomas, depressed skull fractures, the placement of external ventricular drains and the application of decompressive craniectomy.

The overall goal of all surgical treatment is to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimise swelling and pressure. Survival from traumatic head injury has improved significantly over the last 20 years, reflecting improved pre-hospital and neuro-intensive care management of head-injured patients, as well as the introduction of the NICE head injury guidelines in 2003, which has led to a greater number of trauma patients undergoing computed tomography (CT) of the head.

Type
Chapter
Information
Traumatic Brain Injury
A Multidisciplinary Approach
 , pp. 207 - 221
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fountain, DM, Kolias, AG, Lecky, FE, et al. Survival trends after surgery for acute subdural hematoma in adults over a 20-year period. Ann Surg 2017;265:590–6. doi:10.1097/SLA.0000000000001682Google Scholar
Le Roux, P. Intracranial pressure monitoring and management. In: Laskowitz, D, Grant, G, eds. Translational research in traumatic brain injury. Boca Raton, FL: CRC Press/Taylor and Francis Group; 2016. www.ncbi.nlm.nih.gov/books/NBK326713/Google Scholar
Bullock, R, Golek, J, Blake, G. Traumatic intracerebral hematoma–which patients should undergo surgical evacuation? CT scan features and ICP monitoring as a basis for decision making. Surg Neurol 1989;32:181–7.Google Scholar
Badri, S, Chen, J, Barber, J, et al. Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. Intensive Care Med 2012;38:1800–9. doi:10.1007/s00134-012-2655-4CrossRefGoogle ScholarPubMed
Uzan, M, Yentür, E, Hanci, M, et al. Is it possible to recover from uncal herniation? Analysis of 71 head injured cases. J Neurosurg Sci 1998;42:89–94.Google ScholarPubMed
Kuday, C, Uzan, M, Hanci, M. Statistical analysis of the factors affecting the outcome of extradural haematomas: 115 cases. Acta Neurochir (Wien) 1994;131:203–6.Google Scholar
Lee, EJ, Hung, YC, Wang, LC, et al. Factors influencing the functional outcome of patients with acute epidural hematomas: analysis of 200 patients undergoing surgery. J Trauma 1998;45:946–52.Google Scholar
van den Brink, WA, Zwienenberg, M, Zandee, SM, et al. The prognostic importance of the volume of traumatic epidural and subdural haematomas revisited. Acta Neurochir (Wien) 1999;141:509–14.Google Scholar
Bricolo, AP, Pasut, LM. Extradural hematoma: toward zero mortality: a prospective study. Neurosurgery 1984;14:8–12.Google Scholar
Rivas, JJ, Lobato, RD, Sarabia, R, et al. Extradural hematoma: analysis of factors influencing the courses of 161 patients. Neurosurgery 1988;23:44–51.CrossRefGoogle ScholarPubMed
Cohen, JE, Montero, A, Israel, ZH. Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma 1996;41:120–2.CrossRefGoogle ScholarPubMed
Lobato, RD, Cordobes, F, Rivas, JJ, et al. Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study. J Neurosurg 1983;59:762–74. doi:10.3171/jns.1983.59.5.0762Google Scholar
Caroli, M, Locatelli, M, Campanella, R, et al. Multiple intracranial lesions in head injury: clinical considerations, prognostic factors, management, and results in 95 patients. Surg Neurol 2001;56:82–8.CrossRefGoogle ScholarPubMed
Sakas, DE, Bullock, MR, Teasdale, GM. One-year outcome following craniotomy for traumatic hematoma in patients with fixed dilated pupils. J Neurosurg 1995;82:961–5. doi:10.3171/jns.1995.82.6.0961Google Scholar
Mendelow, AD, Karmi, MZ, Paul, KS, et al. Extradural haematoma: effect of delayed treatment. Br Med J 1979;1:1240–2.Google Scholar
Haselsberger, K, Pucher, R, Auer, LM. Prognosis after acute subdural or epidural haemorrhage. Acta Neurochir (Wien) 1988;90:111–16.Google Scholar
Wilberger, JE, Harris, M, Diamond, DL. Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 1991;74:212–18. doi:10.3171/jns.1991.74.2.0212Google Scholar
Seelig, JM, Becker, DP, Miller, JD, et al. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981;304:1511–18. doi:10.1056/NEJM198106183042503Google Scholar
Tien, HCN, Jung, V, Pinto, R, et al. Reducing time-to-treatment decreases mortality of trauma patients with acute subdural hematoma. Ann Surg 2011;253:1178–83. doi:10.1097/SLA.0b013e318217e339Google Scholar
Dent, DL, Croce, MA, Menke, PG, et al. Prognostic factors after acute subdural hematoma. J Trauma 1995;39:36–42; discussion 42–3.Google Scholar
Heinzelmann, M, Platz, A, Imhof, HG. Outcome after acute extradural haematoma, influence of additional injuries and neurological complications in the ICU. Injury 1996;27:345–9.Google Scholar
Cagetti, B, Cossu, M, Pau, A, et al. The outcome from acute subdural and epidural intracranial haematomas in very elderly patients. Br J Neurosurg 1992;6:227–31.Google Scholar
Jamjoom, A. Justification for evacuating acute subdural haematomas in patients above the age of 75 years. Injury 1992;23:518–20.CrossRefGoogle ScholarPubMed
Choksey, M, Crockard, HA, Sandilands, M. Acute traumatic intracerebral haematomas: determinants of outcome in a retrospective series of 202 cases. Br J Neurosurg 1993;7:611–22.Google Scholar
Servadei, F, Murray, GD, Penny, K, et al. The value of the ‘worst’ computed tomographic scan in clinical studies of moderate and severe head injury. European Brain Injury Consortium. Neurosurgery 2000;46:70–5; discussion 75–7.Google Scholar
Cartmill, M, Dolan, G, Byrne, JL, et al. Prothrombin complex concentrate for oral anticoagulant reversal in neurosurgical emergencies. Br J Neurosurg 2000;14:458–61.Google Scholar
Pollack, CV, Reilly, PA, van Ryn, J, et al. Idarucizumab for dabigatran reversal – full cohort analysis. N Engl J Med 2017;377:431–41. doi:10.1056/NEJMoa1707278Google Scholar
Bullock, MR, Chesnut, R, Ghajar, J, et al. Surgical management of acute epidural hematomas. Neurosurgery 2006;58:S7–15; discussion i–iv.Google Scholar
Jones, NR, Molloy, CJ, Kloeden, CN, et al. Extradural haematoma: trends in outcome over 35 years. Br J Neurosurg 1993;7:465–71.Google Scholar
Grossman, RI. Head trauma. In: Neuroradiology: the requisites. Philadelphia: Mosby; 2003.Google Scholar
Kothari, RU, Brott, T, Broderick, JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996;27:1304–5.CrossRefGoogle ScholarPubMed
Cucciniello, B, Martellotta, N, Nigro, D, et al. Conservative management of extradural haematomas. Acta Neurochir (Wien) 1993;120:47–52.Google Scholar
Bullock, R, Smith, RM, van Dellen, JR. Nonoperative management of extradural hematoma. Neurosurgery 1985;16:602–6.CrossRefGoogle ScholarPubMed
Bejjani, GK, Donahue, DJ, Rusin, J, et al. Radiological and clinical criteria for the management of epidural hematomas in children. Pediatr Neurosurg 1996;25:302–8.Google Scholar
Servadei, F, Faccani, G, Roccella, P, et al. Asymptomatic extradural haematomas: results of a multicenter study of 158 cases in minor head injury. Acta Neurochir (Wien) 1989;96:39–45.Google Scholar
Gennarelli, TA, Thibault, LE. Biomechanics of acute subdural hematoma. J Trauma 1982;22:680–6.Google Scholar
Maxeiner, H, Wolff, M. Pure subdural hematomas: a postmortem analysis of their form and bleeding points. Neurosurgery 2002;50:503–8; discussion 508–9.Google Scholar
Mathew, P, Oluoch-Olunya, DL, Condon, BR, et al. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management. Acta Neurochir (Wien) 1993;121:100–8.Google Scholar
Givner, A, Gurney, J, O’Connor, D, et al. Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury. J Pediatr Surg 2002;37:381–5.Google Scholar
Oertel, M, Kelly, DF, McArthur, D, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg 2002;96:109–16. doi:10.3171/jns.2002.96.1.0109CrossRefGoogle ScholarPubMed
Bullock, MR, Chesnut, R, Ghajar, J, et al. Surgical management of acute subdural hematomas. Neurosurgery 2006;58:S16–24; discussion i–iv.Google Scholar
Servadei, F, Nasi, MT, Cremonini, AM, et al. Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. J Trauma 1998;44:868–73.Google Scholar
Rescue ASDH. www.rescueasdh.orgGoogle Scholar
dex-CSDH Trial. www.dexcsdh.orgGoogle Scholar
Brennan, PM, Kolias, AG, Joannides, AJ, et al. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom. J Neurosurg 2017;127:732–9. doi:10.3171/2016.8.JNS16134CrossRefGoogle ScholarPubMed
Mayer, S, Rowland, L. Head injury. In: Merritt’s Neurology. Philadelphia: Lippincott Williams & Wilkins; 2000.Google Scholar
Labadie, EL, Glover, D. Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparisons of subcutaneous hematoma in rats with subdural hematoma in man. J Neurosurg 1976;45:382–92. doi:10.3171/jns.1976.45.4.0382CrossRefGoogle ScholarPubMed
Yadav, Y, Parihar, V, Namdev, H, et al. Chronic subdural hematoma. Asian J Neurosurg 2016;11:330. doi:10.4103/1793-5482.145102Google ScholarPubMed
Berghauser Pont, LME, Dirven, CMF, Dippel, DWJ, et al. The role of corticosteroids in the management of chronic subdural hematoma: a systematic review. Eur J Neurol 2012;19:1397–403. doi:10.1111/j.1468-1331.2012.03768.xGoogle Scholar
Krupa, M. Comparison of two surgical methods as to early results in chronic subdural hematoma. Ann Acad Med Stetin 2009;55:39–47.Google Scholar
Lega, BC, Danish, SF, Malhotra, NR, et al. Choosing the best operation for chronic subdural hematoma: a decision analysis. J Neurosurg 2010;113:615–21. doi:10.3171/2009.9.JNS08825Google Scholar
Markwalder, TM. Chronic subdural hematomas: a review. J Neurosurg 1981;54:637–45. doi:10.3171/jns.1981.54.5.0637Google Scholar
Chon, K-H, Lee, J-M, Koh, E-J, et al. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012;154:1541–8. doi:10.1007/s00701-012-1399-9CrossRefGoogle ScholarPubMed
Santarius, T, Qureshi, HU, Sivakumaran, R, et al. The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma. World Neurosurg 2010;73:747–50. doi:10.1016/j.wneu.2010.03.031Google Scholar
Oh, H-J, Lee, K-S, Shim, J-J, et al. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc 2010;48:518–23. doi:10.3340/jkns.2010.48.6.518Google Scholar
Aoki, N. Subdural tapping and irrigation for the treatment of chronic subdural hematoma in adults. Neurosurgery 1984;14:545–8.Google Scholar
Suzuki, K, Sugita, K, Akai, T, et al. Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surg Neurol 1998;50:231–4.CrossRefGoogle ScholarPubMed
Benzel, EC, Bridges, RM, Hadden, TA, et al. The single burr hole technique for the evacuation of non-acute subdural hematomas. J Trauma 1994;36:190–4.Google Scholar
Santarius, T, Kirkpatrick, PJ, Ganesan, D, et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet Lond Engl 2009;374:1067–73. doi:10.1016/S0140-6736(09)61115-6Google ScholarPubMed
Ishfaq, A, Ahmed, I, Bhatti, SH. Effect of head positioning on outcome after burr hole craniostomy for chronic subdural haematoma. J Coll Physicians Surg–Pak JCPSP 2009;19:492–5. doi:08.2009/JCPSP.492495Google Scholar
Abouzari, M, Rashidi, A, Rezaii, J, et al. The role of postoperative patient posture in the recurrence of traumatic chronic subdural hematoma after burr-hole surgery. Neurosurgery 2007;61:794–7; discussion 797. doi:10.1227/01.NEU.0000298908.94129.67Google Scholar
Yamaki, T, Hirakawa, K, Ueguchi, T, et al. Chronological evaluation of acute traumatic intracerebral haematoma. Acta Neurochir (Wien) 1990;103:112–5.Google Scholar
Gentleman, D, Nath, F, Macpherson, P. Diagnosis and management of delayed traumatic intracerebral haematomas. Br J Neurosurg 1989;3:367–72.CrossRefGoogle ScholarPubMed
Sprick, C, Bettag, M, Bock, WJ. Delayed traumatic intracranial hematomas–clinical study of seven years. Neurosurg Rev 1989;12 Suppl 1:228–30.CrossRefGoogle ScholarPubMed
Kaufman, HH, Moake, JL, Olson, JD, et al. Delayed and recurrent intracranial hematomas related to disseminated intravascular clotting and fibrinolysis in head injury. Neurosurgery 1980;7:445–9.Google Scholar
Durham, SR, Liu, KC, Selden, NR. Utility of serial computed tomography imaging in pediatric patients with head trauma. J Neurosurg 2006;105:365–9. doi:10.3171/ped.2006.105.5.365Google ScholarPubMed
Tseng, SH. Delayed traumatic intracerebral hemorrhage: a study of prognostic factors. J Formos Med Assoc Taiwan Yi Zhi 1992;91:585–9.Google Scholar
Gallbraith, S, Teasdale, G. Predicting the need for operation in the patient with an occult traumatic intracranial hematoma. J Neurosurg 1981;55:75–81. doi:10.3171/jns.1981.55.1.0075Google Scholar
Mathiesen, T, Kakarieka, A, Edner, G. Traumatic intracerebral lesions without extracerebral haematoma in 218 patients. Acta Neurochir (Wien) 1995;137:155–63; discussion 163.Google Scholar
Bullock, MR, Chesnut, R, Ghajar, J, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery 2006;58:S25–46; discussion i–iv. doi:10.1227/01.NEU.0000210365.36914.E3Google Scholar
Bullock, MR, Chesnut, R, Ghajar, J, et al. Surgical management of posterior fossa mass lesions. Neurosurgery 2006;58:S47–55; discussion i–iv. doi:10.1227/01.NEU.0000210366.36914.38Google Scholar
Rinkel, GJ, van Gijn, J, Wijdicks, EF. Subarachnoid hemorrhage without detectable aneurysm. A review of the causes. Stroke 1993;24:1403–9.Google Scholar
Eisenberg, HM, Gary, HE, Aldrich, EF, et al. Initial CT findings in 753 patients with severe head injury: a report from the NIH Traumatic Coma Data Bank. J Neurosurg 1990;73:688–98. doi:10.3171/jns.1990.73.5.0688Google Scholar
Holloway, KL, Barnes, T, Choi, S, et al. Ventriculostomy infections: the effect of monitoring duration and catheter exchange in 584 patients. J Neurosurg 1996;85:419–24. doi:10.3171/jns.1996.85.3.0419Google Scholar
Bochicchio, M, Latronico, N, Zappa, S, et al. Bedside burr hole for intracranial pressure monitoring performed by intensive care physicians: a 5-year experience. Intensive Care Med 1996;22:1070–4.Google Scholar
Hayashi, M, Handa, Y, Kobayashi, H, et al. Plateau-wave phenomenon (I). Correlation between the appearance of plateau waves and CSF circulation in patients with intracranial hypertension. Brain J Neurol 1991;114 (Pt 6):2681–91.Google Scholar
Cooper, DJ, Rosenfeld, JV, Murray, L, et al. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011;364:1493–502. doi:10.1056/NEJMoa1102077Google Scholar
Hutchinson, PJ, Kolias, AG, Timofeev, IS, et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 2016;375:1119–30. doi:10.1056/NEJMoa1605215Google Scholar
Jourdan, C, Convert, J, Mottolese, C, et al. Evaluation of the clinical benefit of decompression hemicraniectomy in intracranial hypertension not controlled by medical treatment. Neurochirurgie 1993;39:304–10.Google Scholar
Jennett, B, Miller, JD. Infection after depressed fracture of skull. Implications for management of nonmissile injuries. J Neurosurg 1972;36:333–9. doi:10.3171/jns.1972.36.3.0333Google Scholar
Yokota, H, Eguchi, T, Nobayashi, M, et al. Persistent intracranial hypertension caused by superior sagittal sinus stenosis following depressed skull fracture: case report and review of the literature. J Neurosurg 2006;104:849–52. doi:10.3171/jns.2006.104.5.849Google Scholar
Fuentes, S, Metellus, P, Levrier, O, et al. Depressed skull fracture overlying the superior sagittal sinus causing benign intracranial hypertension: description of two cases and review of the literature. Br J Neurosurg 2005;19:438–42. doi:10.1080/02688690500390193Google Scholar
Heary, RF, Hunt, CD, Krieger, AJ, et al. Nonsurgical treatment of compound depressed skull fractures. J Trauma 1993;35:441–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×