Surgery to Treat Traumatic Brain Injury
Several types of traumatic brain injury require surgery. Surgery to treat TBI may be performed within hours or days of the injury, if a blood clot causes increased intracranial pressure (ICP). Some clots must be removed; others must not be removed because of the danger of disturbing them. Subdural hematomas and intracerebral hemorrhages may also increase ICP, sometimes necessitating surgery.
During acute treatment, swelling in the brain (edema) is monitored and treated. Brain edema can have dire consequences, causing increased pressure inside the head (intracranial pressure or ICP). Because the skull is hard, ICP can compress or squeeze the soft brain tissue against it, preventing blood from circulating adequately in the brain tissue and causing damage to brain cells. Most edema subsides within a few days or weeks, but a few minutes or hours of excessive ICP can cause permanent damage.
To manage this condition, a device called an ICP monitor can be inserted through the skull to provide physicians with a constant pressure reading. If the ICP rises too high, medications are administered to draw fluid out of the brain and into blood vessels, decrease the brain's metabolic requirements, and increase blood flow to the injured tissues. The patient also can be placed on a ventilator to ensure an adequate supply of oxygen (hyperventilation), which is necessary to promote healing. When brain swelling is particularly severe, elevated pressure can only be relieved temporarily by surgically removing a portion of the skull. This allows swollen tissues to bulge out reducing the risk for pressure-induced damage.
A buildup of fluid inside the brain is also a concern in acute treatment for TBI. If the fluid-containing spaces in the brain (ventricles) experience blockage, a neurosurgeon must insert a tube called a shunt to drain the fluid build up (hydrocephalus). This allows the ventricles to shrink and restores normal function to brain cells. Elevated ICP due to swelling, hydrocephalus, or blood clots significantly impacts recovery from TBI.