CHAPTER 322 Introduction to Traumatic Brain Injury
Traumatic brain injury (TBI) remains the leading cause of death and long-term disability in people younger than 40 years worldwide. Although the incidence of closed TBI in “developed regions” such as Europe, North America, Japan, and Australia continues to fall, its incidence is rising at epidemic proportions in regions with rapidly increasing motorization because of industrialized development. This incidence varies from 67 to 317 per 100,000 individuals, and mortality rates range from around 4% to 8% for moderate injury to approximately 50% with severe head injury. In some rapidly developing countries such as China, Brazil, Colombia, and India, the availability of neurosurgical expertise is a major limiting factor that contributes to poor outcome in patients sustaining neurotrauma; however, this is changing rapidly, and there are now almost as many neurosurgeons practicing in Brazil as there are in the United States, and more are practicing in China than in any other country. Thus, for many of the world’s neurosurgeons, neurotrauma remains the most common major disorder that they are called on to treat.
Recently, neurosurgeons in developed countries have seen dramatic changes in their practice patterns, with increasing numbers of patients being managed with nonoperative interventions, such as endovascular treatment of intracranial aneurysms and radiosurgical treatment of an increasing range of intracranial tumors. However, the need for neurosurgeons to be involved in the management of moderate and severe TBI is greater than ever with the emergence of decompressive craniotomy and multimodality monitoring techniques together with modern neurological intensive care, which have combined to produce dramatic reductions in mortality rates from around 80% for severe TBI in the 1950s to about 20% for severe TBI reported by many of the specialized centers in the last 5 years. About 80,000 craniotomies for removal of intracranial hematomas are preformed in the United States each year, and the figure is slightly higher in Pakistan, as an example. Population-based studies have shown that the single most cost-effective surgical operation is removal of an acute epidural hematoma, given the severe consequences of that hematoma in terms of death or vegetative survival.
It is also well known that at the levels of trauma care systems and organizations, the impact that neurosurgeons can have on the populations that they serve may be large and disproportionate to the small size of the specialty. Examples include working with trauma surgeons to improve prehospital care, improving the quality of trauma systems and emergency departments for trauma victims in general, and optimizing neurocritical care. The dramatic reductions seen in mortality rates for patients with neurotrauma are directly attributable to systems-based collaborations such as this; yet in a majority of cities in rapidly developing countries, such systems are nonexistent or inadequate. Therefore, the need to mentor and foster such interdisciplinary, collaborative trauma care systems among neurosurgeons and other health care providers in these developing countries is clear. It is through these efforts that evidence-based guidelines for the prehospital, surgical, medical, and pediatric management of severe TBI have emerged (Table 322-1).
TABLE 322-1 Evidence-Based Guidelines for Brain Trauma and Internet/Journal Sources
| TITLE OF GUIDELINE DOCUMENT |
YEAR PUBLISHED |
WEBSITE
JOURNAL |
| Management of Severe Head Injury |
1996 |
www.braintrauma.org
J Neurotrauma 1996;13:641-734 |
| Management and Prognosis of Severe TBI, 2nd edition |
2000 |
www.braintrauma.org
J Neurotrauma 2000 |
| Management of Severe TBI, 3rd edition |
2007 |
www.braintrauma.org
J Neurotrauma 2007;24:S71-S76 |
| Prehospital Management of TBI |
2000 |
Buy Membership for Neurosurgery Category to continue reading.
Learn more here
Related
Youmans Neurological Surgery
