The Hudson Brace technique for emergency burr holes, an aide-memoire for the front-line military surgeon

2020 ◽  
pp. bmjmilitary-2020-001546
Author(s):  
James M W Robins ◽  
S Thomson ◽  
AJ Sheikh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cause Of Death ◽  
Surgical Intervention ◽  
British Army ◽  
Cranial Cavity ◽  
Front Line ◽  
Military Surgeon ◽  
Burr Holes ◽  
Early Surgical Intervention

Traumatic brain injury is the leading cause of death in conflict and early surgical intervention achieves better outcomes. The British Army surgical kit includes a Hudson Brace and bit and Gigli saw for decompression of the cranial cavity. Here we demonstrate the Hudson Brace technique for non-neurosurgeons.

scholarly journals Association between suicide risk and traumatic brain injury in adults: a population based cohort study

2020 ◽  
pp. postgradmedj-2019-136860 ◽  
Author(s):  
Yueh-Chien Lu ◽  
Ming-Kung Wu ◽  
Li Zhang ◽  
Cong-Liang Zhang ◽  
Ying-Yi Lu ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Cause Of Death ◽  
Suicide Risk ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Population Based ◽  
Research Database ◽  
Global Public Health

BackgroundTraumatic brain injury (TBI) is a major cause of death and disability worldwide, and its treatment is potentially a heavy economic burden. Suicide is another global public health problem and the second leading cause of death in young adults. Patients with TBI are known to have higher than normal rates of non-fatal deliberate self-harm, suicide and all-cause mortality. The aim of this study was to explore the association between TBI and suicide risk in a Chinese cohort.MethodThis study analysed data contained in the Taiwan National Health Insurance Research Database for 17 504 subjects with TBI and for 70 016 subjects without TBI matched for age and gender at a ratio of 1 to 4. Cox proportional hazard regression analysis was used to estimate subsequent suicide attempts in the TBI group. Probability of attempted suicide was determined by Kaplan-Meier method.ResultsThe overall risk of suicide attempts was 2.23 times higher in the TBI group compared with the non-TBI group (0.98 vs 0.29 per 1000 person-years, respectively) after adjustment for covariates. Regardless of gender, age or comorbidity, the TBI group tended to have more suicide attempts, and the risk attempted suicide increased with the severity of TBI. Depression and alcohol attributed disease also increased the risk of attempted suicide in the TBI group.ConclusionSuicide is preventable if risk factors are recognised. Hence, TBI patients require special attention to minimise their risk of attempted suicide.

Waterjet Assisted Craniotome for Reduced Dural Tears

2018 ◽  
Author(s):  
Mathew Orner ◽  
Michael Greminger ◽  
Amit Goyal
Keyword(s):  
United States ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Tumors ◽  
Cutting Tool ◽  
The United States ◽  
Dural Tears ◽  
Burr Holes ◽  
The Brain ◽  
Gain Access

A craniotomy is a procedure where a piece of the skull is removed in order to gain access to the brain. This is commonly done to remove brain tumors, treat epilepsy, and to treat traumatic brain injury. Currently, the craniotomy procedure involves drilling one or more burr holes and then using a craniotome to complete the cut. The craniotome consists of a rotating cutting tool and a dura guard, which is intended to prevent the cutting tool from touching the dura. However, even with the dura guard, dural tears occur in approximately 20–30% of craniotomy procedures [1], [2]. There are approximately 160,000 craniotomies performed per year in the United States [3]. Dural tears add time to the craniotomy procedure due to the increased difficulty in suturing the dura and the potential need to use synthetic dura material in order to reclose the dura. Also, if the dura tears while using the craniotome, the brain is no longer protected as the craniotomy is completed. There is a strong desire among neurosurgeons to have an improved tool for craniotomies that reduces the incidence of dural tears.

428 Prognostic Determinants of Surgical Intervention in Mild Traumatic Brain Injury

2012 ◽  
Vol 60 (4) ◽  
pp. S151
Author(s):  
L.G. Stead ◽  
A.N. Bodhit ◽  
A. Mazzuoccolo ◽  
P.S. Patel ◽  
Y. Daneshvar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Surgical Intervention

scholarly journals Interdisciplinary Management of Minimally Displaced Orbital Roof Fractures: Delayed Pulsatile Exophthalmos and Orbital Encephalocele

2017 ◽  
Vol 10 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Austin Y. Ha ◽  
William Mangham ◽  
Sarah A. Frommer ◽  
David Choi ◽  
Petra Klinge ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Plastic Surgery ◽  
Vision Loss ◽  
Surgical Intervention ◽  
Interdisciplinary Management ◽  
Management Algorithm ◽  
Orbital Roof ◽  
Close Observation ◽  
Orbital Roof Fractures

Traumatic orbital roof fractures are rare and are managed nonoperatively in most cases. They are typically associated with severe mechanisms of injury and may be associated with significant neurologic or ophthalmologic compromise including traumatic brain injury and vision loss. Rarely, traumatic encephalocele or pulsatile exophthalmos may be present at the time of injury or develop in delayed fashion, necessitating close observation of these patients. In this article, we describe two patients with minimally displaced blow-in type orbital roof fractures that were later complicated by orbital encephalocele and pulsatile exophthalmos, prompting urgent surgical intervention. We also suggest a management algorithm for adult patients with orbital roof fractures, emphasizing careful observation and interdisciplinary management involving plastic surgery, neurosurgery, and ophthalmology.

scholarly journals Patterns and Outcome of Traumatic Brain Injury Patients: A Study in a Tertiary Level Military Hospital

2020 ◽  
Vol 15 (1) ◽  
pp. 75-78
Author(s):  
Md Shohidul Islam ◽  
Md Fashiur Rahman ◽  
Md Aminul Islam
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Head Injury ◽  
Brain Injuries ◽  
Surgical Intervention ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Public Health Problem ◽  
Armed Forces ◽  
Military Hospital

Introduction: A traumatic brain injury (TBI) is an injury to the brain caused by an impact to the head. TBI represents a huge global medical and public health problem across all ages and in both civilian and military populations. TBI is characterized by great heterogeneity in terms of etiology, mechanism, pathology, severity and treatment with widely varying outcomes. Objective: To determine the pattern and outcome of traumatic brain injuries in victims reported to emergency and casualty (E&C) department following intensive care with or without surgical intervention. Materials and Methods: This prospective type of observational study was conducted at Neurosurgery department of Combined Military Hospital, Dhaka from October 2013 to March 2017. A total of 675 head injury patients with TBI were assessed with gender, age, cause and type of trauma, GCS on admission, associated other injuries, time lapsed from trauma to hospitalization and care given. The outcome was measured after 72 hours using Glasgow Outcome Scale (GOS). Results: The incidence of TBI was 47.03% among the head injury patients. Common age group was 21-30 years (43.7%) and male victims (66.55%). RTA was the most frequent cause (50.05%) of TBI and the most common pathophysiological cause of TBI was subdural haemorrhage (SDH)(35%) followed by extradural haemorrhage (EDH)(27%). Most patients (45%) had mild TBI. Surgical intervention was required in 45% patients of TBI mainly for the SDH, EDH which had significant positive effect on the TBI patient’s outcome. The majority of patients (77%) had good outcome which included recovery (51.85%) and moderate disability (25.48%). The poor outcome was observed in 23% patients which included death (7.40%), persistent vegetative state (3.11%), severe disability (12.14%) and it was associated with older age, severe TBI (GCS<8 on admission), associated other injuries and delayed resuscitative care and interventions. Conclusion: TBI was common among the young adults male. The RTA was the leading cause of TBI. The factors that influence the outcome of TBI include patient’s age, severity of TBI, associated injuries and delayed resuscitative care. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 75-78

scholarly journals The Role of Surgical Intervention in Traumatic Brain Injury

2016 ◽  
Vol 27 (4) ◽  
pp. 519-528 ◽  
Author(s):  
Hadie Adams ◽  
Angelos G. Kolias ◽  
Peter J. Hutchinson
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Surgical Intervention

Surgical intervention and patient factors associated with poor outcomes in patients with traumatic brain injury at a tertiary care hospital in Uganda

2021 ◽  
pp. 1-10
Author(s):  
Charis A. Spears ◽  
Syed M. Adil ◽  
Brad J. Kolls ◽  
Michael E. Muhumza ◽  
Michael M. Haglund ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Low Income ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Care Hospital ◽  
Treatment Variable ◽  
Patient Factors ◽  
Poor Outcome ◽  
Poor Outcomes

OBJECTIVE The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors. METHODS Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13–15), moderate TBI (moTBI; GCS scores 9–12), and severe TBI (sTBI; GCS scores 3–8). Poor outcomes constituted Glasgow Outcome Scale scores 2–3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10. RESULTS Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23–0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04–0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14–0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17–1.17). CONCLUSIONS In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient’s admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.

scholarly journals Outcome in Patients with Isolated Moderate to Severe Traumatic Brain Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
D. Jochems ◽  
K. J. P. van Wessem ◽  
R. M. Houwert ◽  
H. B. Brouwers ◽  
J. W. Dankbaar ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Functional Outcome ◽  
Cause Of Death ◽  
Outcome Data ◽  
Unresponsive Wakefulness Syndrome ◽  
Exclusion Criteria ◽  
Good Functional Outcome ◽  
Cord Injury ◽  
Life Sustaining Treatment

Introduction. Traumatic brain injury (TBI) remains a major cause of death. Withdrawal of life-sustaining treatment (WLST) can be initiated if there is little anticipated chance of recovery to an acceptable quality of life. The aim of this study was firstly to investigate WLST rates in patients with moderate to severe isolated TBI and secondly to assess outcome data in the survivor group. Material and Methods. A retrospective cohort study was performed. Patients aged ≥ 18 years with moderate or severe isolated TBI admitted to the ICU of a single academic hospital between 2011 and 2015 were included. Exclusion criteria were isolated spinal cord injury and referrals to and from other hospitals. Gathered data included demographics, mortality, cause of death, WLST, and Glasgow Outcome Scale (GOS) score after three months. Good functional outcome was defined as GOS > 3. Results. Of 367 patients, 179 patients were included after applying inclusion and exclusion criteria. 55 died during admission (33%), of whom 45 (82%) after WLST. Patients undergoing WLST were older, had worse neurological performance at presentation, and had more radiological abnormalities than patients without WLST. The decision to withdraw life-sustaining treatment was made on the day of admission in 40% of patients. In 33% of these patients, this decision was made while the patient was in the Emergency Department. 71% of survivors had a good functional outcome after three months. No patient left hospital with an unresponsive wakefulness syndrome (UWS) or suffered from UWS after three months. One patient died within three months of discharge. Conclusion. In-hospital mortality in isolated brain injured patients was 33%. The vast majority died after a decision to withdraw life-sustaining treatment. None of the patients were discharged with an unresponsive wakefulness syndrome.

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