J Neurol Surg A Cent Eur Neurosurg 2014; 75 - p67
DOI: 10.1055/s-0034-1383796

Standards for Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results of a Nationwide Study

F. Rossi-Mossuti 1, U. Fisch 2, M. M. L. Rebetez 3, P. Schoettker 4, M. Gugliotta 1, K. Kothbauer 5, M. Morard 1, P. Schucht 7, M. Levivier 8, B. Walder 9, J. Fandino 1
  • 1Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
  • 2Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
  • 3Department of Clinical Psychology, University of Geneva, Geneva, Switzerland
  • 4Department of Anaesthesiology, University Hospital Center of Lausanne, Lausanne, Switzerland
  • 5Department of Neurosurgery, Luzerner Kantonsspital, Lucerne, Switzerland
  • 6Department of Neurosurgery, Hôpital du Valais, Sion, Switzerland
  • 7Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
  • 8Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland
  • 9Division of Anaesthesiology, University Hospital of Geneva, Geneva, Switzerland

Aim: After the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, there is still a lack of knowledge regarding standardized operative procedures nationwide. The aim of this study was to assess the surgical management and monitoring strategies within a nationwide study in patients admitted with severe TBI in our country.

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

Results: This study included 353 patients who underwent surgical treatment of severe TBI out of 921 patients enrolled in PEBITA. 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 (61%) patients presented with midline shift. A total of 97 (27.5%) underwent solely implantation of a catheter/probe for ICP monitoring. A total of 256 (72.5%) patients underwent surgical procedure to treat a focal lesion or decompress the cerebrum. From a total of 290 surgical procedures, excluding ICP probe implantation, craniotomy (137;47.2%) or decompressive craniectomy (133;45.9%) were the most frequent operations performed. The mean size of craniectomy in terms of linear width on the axial slice on CT was 8.4 ± 2.9 cm. Significant intraoperative brain swelling were documented in 50.6% of the procedures. Surgical-related complications were documented in 89 (32%) procedures.

Conclusion: This study demonstrated the heterogeneity and lack of standardized documentation of technical aspects of surgical procedures in patients admitted with severe TBI. Technical strategies such as size of craniectomy or intraoperative ICP measurement were respectively not standardized or systematically documented. The introduction of systematic surgical documentation is needed to reassure standardized guidelines in the surgical treatment of patients presenting with severe TBI in Switzerland.