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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)

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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
 

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