Neurosurgery notes/Trauma/Management of trauma/Surgery

Surgery

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Parent item
Management of trauma
Sub-item
Ventriculostomy
Decompressive craniectomy
  • Initial assessment
    • Neurologic deficits, pupil abnormalities, degree of midline shift, hematoma volume, and the presence/ severity of associated trauma is required to determine the necessity for emergent cranial surgery.
  • As surgical interventions might not always be necessary, there is a risk with conservative management of neurological deterioration with possible secondary insults to the brain that may negatively impact the patient’s outcome
  • Traumatic intracranial masses should be treated as indicated.
    • Acute subdural
      • RESCUE-ASDH
    • Contusion:
      • Removal of large areas of contused hemorrhagic brain (makes room immediately; removes region of disrupted BBB).
      • If contused, consider
        • Temporal tip lobectomy
          • No more than 4–5cm on dominant side
          • 6–7cm on non-dominant
          • Total temporal lobectomy is probably too aggressive
        • Frontal lobectomy
          • Has not shown great therapeutic promise