SURGICAL MANAGEMENT OF TRAUMATIC BRAIN INJURY

SURGICAL MANAGEMENT OF

TRAUMATIC BRAIN INJURY

Edward (Ned) Hames, III, M.D., Ph.D., F.A.C.S.

University of Minnesota Physicians

Fairview Southdale Neurosurgery Clinic

Spine, Brain and Stroke Institute

CDC DEFINITION of Traumatic Brain

Injury (TBI)

• An occurrence of injury to the head (arising

from blunt or penetrating trauma) or from

acceleration/deceleration forces that causes

craniocerebral trauma.

Spine, Brain and Stroke Institute

SYMPTOMS ATTRIBUTABLE TO TBI

1. Amnesia

2. Decreased levels of consciousness

3. Skull fracture

4. Diagnosed intracranial abnormalities

5. Death

6. Other neurological of neuropsychological

abnormalities

TRAUMATIC BRAIN INJURY

• Case definitions and inclusion criteria vary

tremendously from one study to another

BRAIN INJURY OCCURRENCES

• Rates range from

92 ≥ 618/100,000 population

• Fatal and nonfatal hospitalized brain injuries

in the Midwest urban areas 150/100,000

population

• The extent of E.D. and non E.D. diagnosis

and treatment of TBI is unknown

HIGH RISK GROUP

CHARACTERISTICS

• Age 15-24 years> 72 years

• Gender M:F = 3:1

• Alcohol

• Low income families

• Relative risk of recurrence TBI with previous

injury in 3 times higher than general

population risk

CONTUSION

VS

CONCUSSION

CONCUSSION SEVERITY

GRADE SYMPTOMS

1. Mild - transient confusion

- symptoms of mental status

abnormalities < then 15 min

2. Moderate - transient confusion

- mental status abnormalities

> 15 min

3. Severe

LOSS of

CONSCIOUSNESS

No

No

ANY loss of consciousness

GLASCOW COMA SCALE

• A clinical prognostic indicator which is an

important contribution to standardizing early

and continued assessments of the severity of

brain injury

TYPES OF BRAIN LESIONS

A) Intracranial WITH skull fracture

B) Intracranial WITHOUT skull fracture

- Hemorrhage

- Contusion

- Laceration

ANATOMYScalp= skin and subcutaneous tissue

galea poneurotia

Skull= Outter Table

Diploe

Inner Table

Intracranial

Dura Mater

Epidural Space

Subdural Space

Pia Mater

SubarachnoidalSpace

Cerebrum

Skull Fracture

Open (Compound)

Closed

Linear skull fracture

Compound skull fracture

Depressed skull fracture

Basilar skull fracture

EPIDURAL HEMATOMA

• 3-4% of major head injuries

• The source is usually arterial

SUBDURAL HEMATOMAS

• Usually the result of an acute venous

hemorrhage caused by rupture of cortical

bridging veins

INTRACEREBRAL HEMATOMA-

CONTUSION