Clinical and surgical management

Clinical and surgical management of cranio-cerebral traumas – F. Servadei, Italy

Decision: transport patient to center w neurosurgery vs keep in regular hospital

2-fold death rate outside neurosurgery

GCS can not be evaluated in sedated patients.

Clinical+radiology findings decide the need for transport - modified marshall - 20-30% transferred

Referred to neurosurgery for ICP monitoring or for immediate surgery as well as new findings on CT

Lesions may evolve!

1/7 type II and 1/5 type III evolve into lesion needing intervention.

1/6 patients with diffuse injury will demonstrate CT evolution - therefore repeated scans and

evaluation based on worst CT scan is needed.

contusions develop within 8h-3days

EDH progress within 24 hours if at all

1/3 of patients arriving at neurosurgery are already sedated

Same radiological findings in patients with different clinical symptoms -> changes decision of surgery

Approx 25-30 % of decisions for delayed surgery based on each of clinical deterioration, radiological, ICP.

Decompression- better ICP, less midline shift but not better perfusion

Australian study - decompression gave better ICP but not better outcome

Primary decompression is another thing - for removing the hemmorhage

Complications - fungus cerebri, infection, hydrocefalus, contralateral EDH. ipsilateral contusion.