SURGICAL MANAGEMENT OF
TRAUMATIC BRAIN INJURY
Edward (Ned) Hames, III, M.D., Ph.D., F.A.C.S.
University of Minnesota Physicians
Fairview Southdale Neurosurgery Clinic
Spine, Brain and Stroke Institute
CDC DEFINITION of Traumatic Brain
Injury (TBI)
• An occurrence of injury to the head (arising
from blunt or penetrating trauma) or from
acceleration/deceleration forces that causes
craniocerebral trauma.
Spine, Brain and Stroke Institute
SYMPTOMS ATTRIBUTABLE TO TBI
1. Amnesia
2. Decreased levels of consciousness
3. Skull fracture
4. Diagnosed intracranial abnormalities
5. Death
6. Other neurological of neuropsychological
abnormalities
TRAUMATIC BRAIN INJURY
• Case definitions and inclusion criteria vary
tremendously from one study to another
BRAIN INJURY OCCURRENCES
• Rates range from
92 ≥ 618/100,000 population
• Fatal and nonfatal hospitalized brain injuries
in the Midwest urban areas 150/100,000
population
• The extent of E.D. and non E.D. diagnosis
and treatment of TBI is unknown
HIGH RISK GROUP
CHARACTERISTICS
• Age 15-24 years> 72 years
• Gender M:F = 3:1
• Alcohol
• Low income families
• Relative risk of recurrence TBI with previous
injury in 3 times higher than general
population risk
CONTUSION
VS
CONCUSSION
CONCUSSION SEVERITY
GRADE SYMPTOMS
1. Mild - transient confusion
- symptoms of mental status
abnormalities < then 15 min
2. Moderate - transient confusion
- mental status abnormalities
> 15 min
3. Severe
LOSS of
CONSCIOUSNESS
No
No
ANY loss of consciousness
GLASCOW COMA SCALE
• A clinical prognostic indicator which is an
important contribution to standardizing early
and continued assessments of the severity of
brain injury
TYPES OF BRAIN LESIONS
A) Intracranial WITH skull fracture
B) Intracranial WITHOUT skull fracture
- Hemorrhage
- Contusion
- Laceration
ANATOMYScalp= skin and subcutaneous tissue
galea poneurotia
Skull= Outter Table
Diploe
Inner Table
Intracranial
Dura Mater
Epidural Space
Subdural Space
Pia Mater
SubarachnoidalSpace
Cerebrum
Skull Fracture
Open (Compound)
Closed
Linear skull fracture
Compound skull fracture
Depressed skull fracture
Basilar skull fracture
EPIDURAL HEMATOMA
• 3-4% of major head injuries
• The source is usually arterial
SUBDURAL HEMATOMAS
• Usually the result of an acute venous
hemorrhage caused by rupture of cortical
bridging veins
INTRACEREBRAL HEMATOMA-
CONTUSION
