Download PDF
J Neurol Surg A Cent Eur Neurosurg 2016; 77(01): 036-045
DOI: 10.1055/s-0035-1563556
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results from a Multicenter Study

Frédéric Rossi-Mossuti
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
,
Urs Fisch
2   Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
,
Patrick Schoettker
3   Department of Anaesthesiology, University Hospital Center of Lausanne, Lausanne, Switzerland
,
Marinella Gugliotta
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
,
Marc Morard
4   Department of Neurosurgery, Hôpital du Valais, Sion, Switzerland
,
Philippe Schucht
5   Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
,
Bawarjan Schatlo
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
8   Department of Neurosurgery, University Hospital Goettingen, Germany
,
Marc Levivier
6   Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
,
Bernhard Walder
7   Division of Anaesthesiology, University Hospital of Geneva, Geneva, Switzerland
,
Javier Fandino
1   Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
› Author Affiliations
Further Information

Publication History

01 September 2014

03 July 2015

Publication Date:
09 September 2015 (online)

    Permissions and Reprints

Abstract

Objective Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe TBI.

Methods Demographic, clinical, and radiologic data from a prospective national cohort study on severe brain-injured patients (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents [PEBITA]) were collected during a 3-year period. This study evaluated patients admitted to 7 of the 11 trauma centers included in PEBITA. We retrospectively analyzed surgery-related computed tomography (CT) findings prior to and after treatment, intracranial pressure (ICP) monitoring, size and technical features of craniotomy, as well as surgical complications.

Results This study included 353 of the 921 patients enrolled in PEBITA who underwent surgical treatment for severe TBI. At admission, acute subdural hematoma was the most frequent focal lesion diagnosed (n = 154 [44%]), followed by epidural hematoma (n = 96 [27%]) and intracerebral hematoma (n = 84 [24%]). A total of 198 patients (61%) presented with midline shift. Clinical deterioration in terms of Glasgow Coma Scale scores or intractable ICP values as an indication for surgical evacuation or decompression were documented in 20% and 6%, respectively. A total of 97 (27.5%) only received a catheter/probe for ICP monitoring. Surgical procedures to treat a focal lesion or decompress the cerebrum were performed in 256 patients (72.5%). Of the 290 surgical procedures (excluding ICP probe implantation), craniotomy (137 [47.2%]) or decompressive craniectomy (133 [45.9%]) were performed most frequently. The mean size of craniectomy in terms of maximal linear width on the CT axial slice was 8.4 ± 2.9 cm. Intraoperative ICP monitoring was reported in 61% of the interventions. Significant intraoperative brain swelling was documented in 50.6% of the procedures. Surgery-related complications occurred in 89 cases (32%).

Conclusion This study highlights the lack of standardized and systematic documentation of technical aspects of surgical treatment of patients presenting with severe TBI in Switzerland. Technical strategies such as size of craniectomy and the use of perioperative ICP measurement were not documented in a standardized manner. A prospective systematic surgical documentation system might contribute to future formulation of recommendations for the surgical treatment of patients presenting with severe TBI in Switzerland.

Keywords

severe traumatic brain injury - surgical management and monitoring strategies - standardized documentation - standardized operative procedures - neurosurgery
 

  • References

  • 1 Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E, Lossius HM. Epidemiology and contemporary patterns of trauma deaths: changing place, similar pace, older face. World J Surg 2007; 31 (11) 2092-2103
    CrossrefPubMedGoogle Scholar
  • 2 Myburgh JA, Cooper DJ, Finfer SR , et al; Australasian Traumatic Brain Injury Study (ATBIS) Investigators for the Australian; New Zealand Intensive Care Society Clinical Trials Group. Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma 2008; 64 (4) 854-862
    CrossrefPubMedGoogle Scholar
  • 3 Murray GD, Teasdale GM, Braakman R , et al. The European Brain Injury Consortium survey of head injuries. Acta Neurochir (Wien) 1999; 141 (3) 223-236
    CrossrefPubMedGoogle Scholar
  • 4 Hawthorne G, Gruen RL, Kaye AH. Traumatic brain injury and long-term quality of life: findings from an Australian study. J Neurotrauma 2009; 26 (10) 1623-1633
    CrossrefPubMedGoogle Scholar
  • 5 Lippert-Grüner M, Kuchta J, Hellmich M, Klug N. Neurobehavioural deficits after severe traumatic brain injury (TBI). Brain Inj 2006; 20 (6) 569-574
    CrossrefPubMedGoogle Scholar
  • 6 von Steinbüchel N, Wilson L, Gibbons H , et al; QOLIBRI Task Force. Quality of Life after Brain Injury (QOLIBRI): scale development and metric properties. J Neurotrauma 2010; 27 (7) 1167-1185
    CrossrefPubMedGoogle Scholar
  • 7 van Velzen JM, van Bennekom CA, Edelaar MJ, Sluiter JK, Frings-Dresen MH. Prognostic factors of return to work after acquired brain injury: a systematic review. Brain Inj 2009; 23 (5) 385-395
    CrossrefPubMedGoogle Scholar
  • 8 McGarry LJ, Thompson D, Millham FH , et al. Outcomes and costs of acute treatment of traumatic brain injury. J Trauma 2002; 53 (6) 1152-1159
    CrossrefPubMedGoogle Scholar
  • 9 Mushkudiani NA, Engel DC, Steyerberg EW , et al. Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24 (2) 259-269
    CrossrefPubMedGoogle Scholar
  • 10 Tohme S, Delhumeau C, Zuercher M, Haller G, Walder B. Prehospital risk factors of mortality and impaired consciousness after severe traumatic brain injury: an epidemiological study. Scand J Trauma Resusc Emerg Med 2014; 22: 1
    CrossrefPubMedGoogle Scholar
  • 11 Walder B, Haller G, Rebetez MM , et al. Severe traumatic brain injury in a high-income country: an epidemiological study. J Neurotrauma 2013; 30 (23) 1934-1942
    CrossrefPubMedGoogle Scholar
  • 12 Jourdan C, Bosserelle V, Azerad S , et al; members of the steering committee of the PariS-TBI study. Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study. Brain Inj 2013; 27 (9) 1000-1007
    CrossrefPubMedGoogle Scholar
  • 13 Andelic N, Anke A, Skandsen T , et al. Incidence of hospital-admitted severe traumatic brain injury and in-hospital fatality in Norway: a national cohort study. Neuroepidemiology 2012; 38 (4) 259-267
    CrossrefPubMedGoogle Scholar
  • 14 Maegele M, Engel D, Bouillon B , et al. Incidence and outcome of traumatic brain injury in an urban area in Western Europe over 10 years. Eur Surg Res 2007; 39 (6) 372-379
    PubMedGoogle Scholar
  • 15 Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir (Wien) 2006; 148 (3) 255-268 ; discussion 268
    CrossrefPubMedGoogle Scholar
  • 16 Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008; 7 (8) 728-741
    Google Scholar
  • 17 Masson F, Thicoipe M, Aye P , et al; Aquitaine Group for Severe Brain Injuries Study. Epidemiology of severe brain injuries: a prospective population-based study. J Trauma 2001; 51 (3) 481-489
    CrossrefPubMedGoogle Scholar
  • 18 Gregson BA, Rowan EN, Mitchell PM , et al. Surgical trial in traumatic intracerebral hemorrhage (STITCH[Trauma]): study protocol for a randomized controlled trial. Trials 2012; 13: 193
    CrossrefPubMedGoogle Scholar
  • 19 Cooper DJ, Rosenfeld JV, Murray L , et al; DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 2011; 364 (16) 1493-1502
    CrossrefPubMedGoogle Scholar
  • 20 Hutchinson PJ, Corteen E, Czosnyka M , et al. Decompressive craniectomy in traumatic brain injury: the randomized multicenter RESCUEicp study (www.RESCUEicp.com). Acta Neurochir Suppl (Wien) 2006; 96: 17-20
    PubMedGoogle Scholar
  • 21 Compagnone C, Murray GD, Teasdale GM , et al; European Brain Injury Consortium. The management of patients with intradural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery 2005; 57 (6) 1183-1192 ; discussion 1183–1192
    CrossrefPubMedGoogle Scholar
  • 22 Bullock MR, Chesnut R, Ghajar J , et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute epidural hematomas. Neurosurgery 2006; 58 (3, Suppl): S7-S15 ; discussion Si-iv
    PubMedGoogle Scholar
  • 23 Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007; 24 (Suppl. 01) S1-S106
    CrossrefPubMedGoogle Scholar
  • 24 Shigemori M, Abe T, Aruga T , et al; Guidelines Committee on the Management of Severe Head Injury, Japan Society of Neurotraumatology. Guidelines for the Management of Severe Head Injury, 2nd Edition guidelines from the Guidelines Committee on the Management of Severe Head Injury, the Japan Society of Neurotraumatology. Neurol Med Chir (Tokyo) 2012; 52 (1) 1-30
    CrossrefPubMedGoogle Scholar
  • 25 Firsching R, Piek J, Skalej M, Rohde V, Schmidt U, Striggow F ; KN38-7271 Study Group. Early survival of comatose patients after severe traumatic brain injury with the dual cannabinoid CB1/CB2 receptor agonist KN38-7271: a randomized, double-blind, placebo-controlled phase II trial. J Neurol Surg A Cent Eur Neurosurg 2012; 73 (4) 204-216
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Taussky P, Widmer HR, Takala J, Fandino J. Outcome after acute traumatic subdural and epidural haematoma in Switzerland: a single-centre experience. Swiss Med Wkly 2008; 138 (19–20) 281-285
    PubMedGoogle Scholar
  • 27 Taussky P, Fandino J, Landolt H. Number of burr holes as independent predictor of postoperative recurrence in chronic subdural haematoma. Br J Neurosurg 2008; 22 (2) 279-282
    CrossrefPubMedGoogle Scholar
  • 28 Zuercher M, Ummenhofer W, Baltussen A, Walder B. The use of Glasgow Coma Scale in injury assessment: a critical review. Brain Inj 2009; 23 (5) 371-384
    CrossrefPubMedGoogle Scholar
  • 29 Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT ; Workshop Scientific Team and Advisory Panel Members. Classification of traumatic brain injury for targeted therapies. J Neurotrauma 2008; 25 (7) 719-738
    CrossrefPubMedGoogle Scholar
  • 30 Pasqualin A, Barone G, Cioffi F, Rosta L, Scienza R, Da Pian R. The relevance of anatomic and hemodynamic factors to a classification of cerebral arteriovenous malformations. Neurosurgery 1991; 28 (3) 370-379
    CrossrefPubMedGoogle Scholar
  • 31 Bullock MR, Chesnut R, Ghajar J , et al; Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute subdural hematomas. Neurosurgery 2006; 58 (3, Suppl): S16-S24 ; discussion Si-iv
    PubMedGoogle Scholar
  • 32 Mendelow AD, Karmi MZ, Paul KS, Fuller GA, Gillingham FJ. Extradural haematoma: effect of delayed treatment. BMJ 1979; 1 (6173) 1240-1242
    CrossrefPubMedGoogle Scholar
  • 33 Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981; 304 (25) 1511-1518
    CrossrefPubMedGoogle Scholar
  • 34 Kaye A. Operative Neurosurgery. 1st ed. London, UK: Churchill Livingstone; 1999
    Google Scholar
  • 35 Winn R. Youmans Neurological Surgery. 6th ed. Philadelphia, PA: Saunders; 2011
    Google Scholar
  • 36 Tagliaferri F, Zani G, Iaccarino C , et al. Decompressive craniectomies, facts and fiction: a retrospective analysis of 526 cases. Acta Neurochir (Wien) 2012; 154 (5) 919-926
    CrossrefPubMedGoogle Scholar
  • 37 Wirtz CR, Steiner T, Aschoff A , et al. Hemicraniectomy with dural augmentation in medically uncontrollable hemispheric infarction. Neurosurg Focus 1997; 2 (5) E3 ; discussion following
    PubMedGoogle Scholar
  • 38 Michel P, Arnold M, Hungerbühler HJ , et al; Swiss Working Group of Cerebrovascular Diseases with the Swiss Society of Neurosurgery and the Swiss Society of Intensive Care Medicine. Decompressive craniectomy for space occupying hemispheric and cerebellar ischemic strokes: Swiss recommendations. Int J Stroke 2009; 4 (3) 218-223
    CrossrefPubMedGoogle Scholar
  • 39 Jiang JY, Xu W, Li WP , et al. Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury: a multicenter, prospective, randomized controlled study. J Neurotrauma 2005; 22 (6) 623-628
    CrossrefPubMedGoogle Scholar
  • 40 Wagner S, Schnippering H, Aschoff A, Koziol JA, Schwab S, Steiner T. Suboptimum hemicraniectomy as a cause of additional cerebral lesions in patients with malignant infarction of the middle cerebral artery. J Neurosurg 2001; 94 (5) 693-696
    CrossrefPubMedGoogle Scholar
  • 41 Skoglund TS, Eriksson-Ritzén C, Jensen C, Rydenhag B. Aspects on decompressive craniectomy in patients with traumatic head injuries. J Neurotrauma 2006; 23 (10) 1502-1509
    CrossrefPubMedGoogle Scholar
  • 42 Chesnut RM, Temkin N, Carney N , et al; Global Neurotrauma Research Group. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367 (26) 2471-2481
    CrossrefPubMedGoogle Scholar
  • 43 Su SH, Wang F, Hai J , et al. The effects of intracranial pressure monitoring in patients with traumatic brain injury. PLoS ONE 2014; 9 (2) e87432
    CrossrefPubMedGoogle Scholar
  • 44 Forsyth RJ, Wolny S, Rodrigues B. Routine intracranial pressure monitoring in acute coma. Cochrane Database Syst Rev 2010; (2) CD002043
    PubMedGoogle Scholar
  • 45 Alexander E, Ball MR, Laster DW. Subtemporal decompression: radiological observations and current surgical experience. Br J Neurosurg 1987; 1 (4) 427-433
    CrossrefPubMedGoogle Scholar
  • 46 Münch E, Horn P, Schürer L, Piepgras A, Paul T, Schmiedek P. Management of severe traumatic brain injury by decompressive craniectomy. Neurosurgery 2000; 47 (2) 315-322 ; discussion 322–323
    CrossrefPubMedGoogle Scholar