Journal of Neurology

, Volume 262, Issue 1, pp 235–238 | Cite as

What’s new in the surgical management of traumatic brain injury?

  • Krunal Patel
  • Angelos G. Kolias
  • Peter J. Hutchinson
Neurological Update


Traumatic brain injury (TBI) remains the commonest cause of death and disability amongst people under the age of 40. Advances in neuro-imaging and neuro-intensive care during the 1980s and 1990s, improved pre-hospital care and the development of major trauma centres in more recent years, have all contributed to the provision of better care and improved outcomes for head-injured patients [ 1]. Here we explore the latest developments in the surgical management of TBI (Table  1).
Table 1

The rationale of surgical interventions for TBI



Evacuation of intracranial haematomas

Reduction of mass effect on the underlying brain and/or brainstem

Decompressive craniectomy

Intracranial compliance improves and ICP is reduced

External ventricular drainage

Intracranial compliance improves and ICP is reduced

Surgery for depressed skull fractures

Debridement reduces the risk of intracranial infection; elevation/reconstruction improves cosmesis

Surgery for post-traumatic...


Neurosurgery Decompressive craniectomy Craniotomy Intracranial haematoma Cerebrospinal fluid Skull fracture 



Angelos Kolias is supported by a Royal College of Surgeons of England Research Fellowship, an NIHR Academic Clinical Fellowship, and a Raymond and Beverly Sackler Studentship. Peter Hutchinson is supported by an NIHR Research Professorship, the NIHR Cambridge Biomedical Research Centre, and has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative.

Conflicts of interest

Peter Hutchinson has delivered lectures sponsored by Codman and is a Director of Technicam Ltd., Newton Abbot, Devon, UK (a manufacturer of cranial access devices for neuromonitoring).


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Krunal Patel
    • 1
  • Angelos G. Kolias
    • 1
  • Peter J. Hutchinson
    • 1
  1. 1.Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s HospitalUniversity of CambridgeCambridgeUK

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