Summary
The future role of the neurosurgeon in the management of head injury is reviewed in terms of the care of patients with minor, moderate and severe head injuries. In minor head injury it is predicted that there will be increasing pressure on the neurosurgeon to undertake the management and follow-up of all patients who have sustained head injury, and this will place a considerable additional load on each neurosurgical unit. This is based on a survey of 1919 head injuries admitted in one calendar year (1981), consisting of 93 severe injuries (GCS < 8), 210 moderate injuries (GCS 8–12), and 1616 minor injuries (GCS 13/14). In moderate injuries CT will assume a major role in detecting hematoma early and identifying contusions. There may yet be a role for steroids in these cases and there should be a greater use of neurorehabilitation, instead of the current overemphasis on the severely injured. In severe injury future efforts will be to prevent early secondary insults and to find better methods of controlling raised intracranial pressure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Braakman, R., H. J. A. Schouten, M. Blaauwn-van Dishoeck, J. M. Minderhoud: Megadose steroids in severe head injury: Results of a prospective doubleblind clinical trial. J. Neurosurg. 58 (1983) 326–330
Jennett, B., G. Teasdale: Aspects of coma after severe head injury. Lancet 1 (1977) 878–881
Jennett, B., G. Teasdale, S. Galbraith, J. Pickard, H. Grant, R. Braakman, C. Avezaat, A. Maas, J. Minderhoud, C. J. Vecht, J. Heiden, R. Small, W. Caton, T. Kurze: Severe head injuries in three countries, J. Neurol. Neurosurg. Psychiatry 40 (1977) 291–298
Langfitt, T. W.: Measuring the outcome from head injuries. J. Neurosurg. 48 (1978) 673–678
Miller, J. D.: Head injuries and brain ischaemia — implications for therapy. Br. J. Anaesth. 57 (1985) 120–130
Miller, J. D., D. P. Becker, J. D. Ward, H. G. Sullivan, W. E. Adams, M. J. Rosner: Significance of intracranial hypertension in severe head injury. N. Neurosurg. 47 (1977) 503–516
Miller, J. D., J. F. Butterworth, S. K. Gudeman, J. E. Faulkner, S. C. Choi, J. B. Selhorst, J. W. Harbison, H. Lutz, H. F. Young, D. P. Becker: Further experience in the management of severe head injury. J. Neurosurg. 54 (1981) 289–299
Miller, J. D., W. B. Jennett: Complications of depressed skull fracture. Lancet 2 (1968) 991–995
Miller, J. D., P. A. Jones: The work of a regional head injury service. Lancet 1 (1985) 1141–1144
Miller, J. D., R. C. Sweet, R. Narayan, D. P. Becker: Early insults to the injured brain. J. Am. Med. Assoc. 240 (1978): 439–442
Rimel, R. W., B. Giordani, J. T. Barth, J. A. Jane: Moderate head injury: Completing the clinical spectrum of brain trauma. Neurosurgery 11 (1982) 344–351
Roy, C. M., B. Pentland, J. D. Miller: Minor head injury in the elderly. (1986) (In press)
Schwartz, M. L., C. H. Tator, D. W. Rowed, S. R. Reid, K. Megura, D. F. Andrews: The University of Toronto head injury treatment study: A prospective randomised comparison of pentobarbital and mannitol. Cana. J. Neurol. Sci. 11 (1984) 434–440
Ward, J. D., D. P. Becker, J. D. Miller, S. C. Choi, A. Marmarou, C. Wood, P. Newlon, R. Keenan: Failure of prophylactic barbiturate coma in the treatment of severe head injury. J. Neurosurg. 62 (1985) 383–388