Surgical Issues in the Management of Head-Injured Patients

This chapter reviews the indications for surgical intervention and operative nuances that may facilitate neurosurgical procedures. We discuss the surgical management of patients with traumatic intracranial haematomas, depressed skull fractures, the placement of external ventricular drains and the application of decompressive craniectomy. The overall goal of all surgical treatment is to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimise swelling and pressure. Survival from traumatic head injury has improved significantly over the last 20 years, reflecting improved pre-hospital and neuro-intensive care management of head-injured patients, as well as the introduction of the NICE head injury guidelines in 2003, which has led to a greater number of trauma patients undergoing computed tomography (CT) of the head.