MODERN PRINCIPLES OF SURGERY SEVERE CRANIOCEREBRAL TRAUMA

Abstract

Nowadays treatment methods of severe traumatic brain injury - state of the problem in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.Surgery of traumatic brain injury (TBI) is the principal direction of research activities in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.With a view to produce an unified approach in treatment patients with TBI, in the neurosurgery department brain injury practical classifications have been designed. Using neurological examination and CT data they allow to diagnose and determine a severity of TBI.The conducted at the department researches allowed to clarify the indications to surgery and nonoperative treatment in patients with posterior cranial fossa injury and small intracranial hematomas. For the first time in Russia there was organized and carried out the randomized trial which was dedicated to the choice of surgery (decompressive craniectomy or craniotomy) in severe TBI. There were identified risk factors of adverse outcomes in patients with severe TBI.There was worked out and embedded in daily practice the new original minimally invasive method of TBI surgery — the puncture aspiration and local fibrinolysis of traumatic intracranial hematomas. In surgery of subacute and chronic hematomas as well as in surgery of traumatic intracranial hematomas which are located in functionally significant regions of the brain, the endoscopy is being used actively. This method allows to reduce damages of surgical approach and keep its radicality. At the present time the researches is being conducted which are dedicated to surgery of acute brain herniation syndrome. Using original tools the minimally traumatic methods of tentorium and falx cerebri incisions were designed as well as the decompressive craniectomy in combination with lower medial temporal resection were developed.Application of new technologies in diagnosis and treatment in patients with TBI as well as introduction in routine practice new types of surgery allowed to decrease noticeably postoperative mortality in operated patients with severe TBI.

Keywords

• severe traumatic brain injury
• diagnosis
• treatment