Treatment strategy at combat traumatic brain injury

Abstract

In 50% of neurosurgical injured persons damage of soft tissues of the head is revealed, in 28% — penetrating, in 17% — non-penetrating. Mine-explosive injuries are observed in almost 70% of the victims.In the structure of traumatic brain injury (TBI) severe injury accounts for 15-20%, moderate and mild — 80-85%. At severe TBI (8 points or less on the Glasgow Coma Scale) 40-60% of the victims die, moderate and mild — 10%; however in 50–90% of the patients in different periods after injury neuropsychiatric disorders are revealed.Closed TBI: concussion, mild, moderate and severe brain contusion, diffuse axonal injury, brain compression at depressed skull fracture, intracranial hematoma (epidural, subdural, intracerebral), cerebral edema progression, liquorodynamic’s disorders. Open TBI: injury with soft tissues damage of the head and without it, aponeurosis and dura mater tampering, scull base fracture.Combat TBI includes gunshot and mine-explosive injuries of the skull and brain, distributed depending on localization and nature of the injury, type of the wound channel, brain and the meningies, etc.CT should be performed in all victims at TBI with a high and moderate risk of intracranial complications occurrence. CT must be repeated after 12–24 hours, and in case of neurological impairment. At contraindications absence MRI is recommended. TBI victims require observation over time and treatment in a specialized neurosurgical unit.Main principals of TBI victims treatment are adequate oxygenation of brain tissue, hypoxia and hypovolemia correction. Hyperglycemia correction promotes cerebroprotection; optimal glucose level in the blood — 5,5–10 mol/l; hypoglycemia 2.2 mol/l or less need to be eliminated urgently. Intracranial pressure requires monitoring, it’s optimum level — below 20 mmHg, cerebral perfusion pressure — 80-90 mmHg.Early use of anticonvulsants and cerebroprotectors in victims with open and penetrating TBI is needed. The effects of combat TBI, including the course of the disease and patients’ survival depend on the terms of emergency, qualified, and specialized neurosurgical care and the adequacy of physical, psyho-neurological, and social adaptation.