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Surgical Management of Traumatic Brain Injury
Surgical Management of Traumatic Brain Injury
Surgical Management of Traumatic Brain Injury
MANAGEMENT OF
TRAUMATIC BRAIN
INJURY
Section of Neurotrauma
University of Mississippi Medical Center
Jackson, Mississippi
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
I. Acute epidural hematomas (EDH).
II. Acute sub-dural hematomas (SDH).
III. Parenchymal lesions & Cranial
Decompression.
IV. Posterior fossa mass lesions.
V. Depressed skull fractures.
VI. Imaging in traumatic brain injury (TBI).
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
I. ACUTE EPIDURAL
HEMATOMAS
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SURGICAL MANAGEMENT OF
ACUTE EPIDURAL HEMATOMAS
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SURGICAL MANAGEMENT OF
ACUTE EPIDURAL HEMATOMAS
Literature
Surgery:
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SURGICAL MANAGEMENT OF
ACUTE EPIDURAL HEMATOMAS
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SURGICAL MANAGEMENT OF
ACUTE EPIDURAL HEMATOMAS
Literature
Timing:
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
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SURGICAL MANAGEMENT OF
ACUTE SUBDURAL
HEMATOMAS
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SURGICAL MANAGEMENT OF
ACUTE SUBDURAL
HEMATOMAS
Literature:
Surgery:
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SURGICAL MANAGEMENT OF
ACUTE SUBDURAL HEMATOMAS
Literature:
Timing:
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SURGICAL MANAGEMENT OF
ACUTE SUBDURAL
HEMATOMAS
Literature:
Timing:
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SURGICAL MANAGEMENT OF
ACUTE SUBDURAL
HEMATOMAS
Literature:
Methods:
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SURGICAL MANAGEMENT OF
ACUTE SUBDURAL
HEMATOMAS
Timing: ASAP.
Methods: Craniotomy.
Craniectomy + duraplasty.
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
III. PARENCHYMAL
LESIONS
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
Literature:
Surgery:
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
Literature:
Surgery:
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
Literature:
Methods:
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
Methods: Hemicraniectomy.
Brifrontal decompressive craniectomy &
duraplasty in patients with diffuse injury
and cerebral edema with medically
refractory elevated ICP.
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SURGICAL MANAGEMENT OF
PARENCHYMAL LESIONS
Methods:
In patients with diffuse injury/cerebral
edema refractory to medical treatment &
impending herniation.
Options:
Subtemporal decompression
Temporal lobectomy
Hemispheric decompressive craniectomy.
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
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SURGICAL MANAGEMENT OF
POSTERIOR FOSSA MASS LESIONS
Literature:
Surgery:
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SURGICAL MANAGEMENT OF
POSTERIOR FOSSA MASS LESIONS
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SURGICAL MANAGEMENT OF
POSTERIOR FOSSA MASS LESIONS
Surgery indicated:
Neurologic dysfunction/deterioration.
Mass effect: 4th ventricle. Basal cisterns.
Obstructive Hydrocephalus
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SURGICAL MANAGEMENT OF
POSTERIOR FOSSA MASS LESIONS
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SURGICAL MANAGEMENT OF
POSTERIOR FOSSA MASS LESIONS
Timing : ASAP
Methods:
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SURGICAL MANAGEMENT OF
POSTERIOR FOSSA MASS LESIONS
Timing : ASAP
Methods:
Operative: Suboccipital craniectomy
Non-operative: Close observation &
Serial imaging
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
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SURGICAL MANAGEMENT OF
DEPRESSED SKULL FRACTURES
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SURGICAL MANAGEMENT OF
DEPRESSED SKULL FRACTURES
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SURGICAL MANAGEMENT OF
DEPRESSED SKULL FRACTURES
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SURGICAL MANAGEMENT OF
DEPRESSED SKULL
FRACTURES
Literature:
Surgery:
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SURGICAL MANAGEMENT OF
DEPRESSED SKULL FRACTURES
Literature:
Surgery:
Heary et al.: Successful non-operative treatment in
absence of significant hematoma, dural
dysruption, depression > 1 cm, sinus involvement,
infection or gross contamination or
pneumocephalus.
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SURGICAL MANAGEMENT OF
DEPRESSED SKULL FRACTURES
Timing:
Early operation to reduce risk of
infection
Methods:
Elevation and debridement
Replacement of bone fragments if not
infected
All compound fxs treatment should include
antibiotics
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
Computed tomography:
Imaging modality of choice.
Adequate interpretation includes:
1. - Status of basal/perimesencephalic
cisterns.
2.- Mass volumetric measurements,
and thickness measurement.
3.- Estimates of midline shift .
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
Computed tomography:
Status of perimesencephalic
cisterns:
1.- Open.
2.- Partially closed/Obliterated.
3.- Completely closed/Obliterated.
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SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
Computed tomography:
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