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
