Zdravniški Vestnik (Dec 2003)
DELAYED NEUROSURGICAL PROCEDURE IN TRAUMATIC BRAIN INJURY PATIENTS
Abstract
Background. Traumatic brain injury is a dynamic process and despite a normal initial CT scan of the head delayed intracranial haematoma which eventually requires surgical intervention may developed. Therefore careful monitoring of the patient with severe traumatic brain injury and repeated CT scans are mandatory.Patients and methods. In the paper we present basic characteristics of the delayed neurosurgical intervention in case of delayed intracerebral haematoma, epidural haematoma and subdural haematoma occurrence. Delayed neurosurgical treatment for the malignant intracranial hypertension, posttraumatic hydrocephalus, cerebrospinal fluid fistula and depressed fracture are also presented. Delayed neurosurgical intervention should be called every intervention that is performed as a result of a control CT scan. We suggest that a control CT scan should be done 8 hours after the initial CT scan and at least once again in the next 48 hours.Conclusions. When the traumatic brain injury patient is treated in a local hospital without neurosurgical care, the phone communication between the surgeon or anaesthesiologist in the local hospital and neurosurgeon is very important. It is mandatory that CT scans are also presented to the neurosurgeon. Because of lack of interest and bad outfit of the roentgen departments which does not allow direct transfer of images between RTG departments, we suggest scanning of images and sending them as email attachments. This would very much improve the communication and decision making. Hospitals that are not able to do so should not treat traumatic brain injury patients. Delayed neurosurgical intervention should be done by the neurosurgeon.
