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Neurosurgical trauma

  1. Department of Neurosurgery
  2. Information for patients
  3. Disease patterns and therapies in an interdisciplinary context
  4. Neurosurgical disease patterns
  5. Neurosurgical trauma

Neurotrauma includes injuries to the central nervous system affecting the head (cranial) and spine (spinal), as well as the surrounding bony structures and ligamentous apparatus, usually resulting from traumatic forces such as accidents, falls, or violence. These injuries can disrupt the functional integrity of the brain or spinal cord.

Immediate care after the injury is critical. Patients must be transported carefully and immobilized to prevent further damage. Neurotrauma can lead to severe neurological deficits, including complete spinal cord injury, and must be diagnosed and treated promptly. Depending on the type (bony, ligamentous, or neuronal) and severity of the injury, treatment may be conservative, but surgical intervention is often required.

At our clinic, modern interdisciplinary surgical protocols in skull base surgery and neurotraumatology, combined with specialized pre- and postoperative neurosurgical intensive care, aim to minimize or prevent long-term complications following neurotrauma.

Common conditions in neurotraumatology include:

Traumatic Brain Injury (TBI) results from a brief external force applied to the skull, leading to brain dysfunction and/or injury. The severity can range from a concussion with no visible or microscopic structural damage to a severe closed or open head injury with brain contusions, intracranial bleeding, and fractures of the skull or skull base.

TBI is classified as follows:

  • Mild TBI (Commotio cerebri): one of the most common neurological conditions.Treatment is mostly symptomatic and pharmacological.
  • Moderate TBI (Contusio cerebri, brain contusion) to Severe TBI (Compressio cerebri, brain compression): in cases of moderate to severe TBI, with impaired consciousness or breathing, intensive care unit admission is usually required. Surgical intervention may be necessary to achieve temporary pressure relief, either through a craniotomy (surgical opening of the skull) or drainage (diversion of cerebrospinal fluid or blood).
  • Closed TBI: brain injury occurs without breach of the dura mater.
  • Open TBI: involves injury to the scalp, skull, and dura mater, creating a direct connection between the intracranial space and the external environment.

The so-called subdural and epidural spaces within the skull are pathological spaces that only develop when hematomas (bleeds) form as a delayed consequence of head trauma. 
Hematomas often become symptomatic due to headaches or neurological deficits, such as hemiparesis or speech disturbances.

Types of hematomas include:

  • Epidural Hematoma (EDH)
    Bleeding occurs between the skull bone and the dura mater. Most commonly caused by a skull fracture with injury to a meningeal artery. Urgent surgical intervention is required to evacuate the hematoma and control the bleeding source.
  • Subdural Hematoma (ASDH)
    Bleeding occurs deeper, between the dura mater and the arachnoid mater. Smaller hematomas can be treated under local anesthesia via a small burr hole in the skull. Larger hematomas, which exert significant pressure on the brain, require a larger burr hole with drainage placement under general anesthesia and sometimes irrigation of the hematoma cavity.

Skull fractures are breaks in the cranial bones caused by external trauma. They can involve the skull vault (calvarial fractures), the skull base (basal skull fractures), or the facial bones.

A skull fracture can be life-threatening and generally requires immediate specialist evaluation and usually surgical treatment. Exceptions include linear calvarial fractures and nasal bone fractures, which are often managed conservatively. Depending on its location, a skull fracture may be associated with meningeal injury. If the fracture creates a communication between air-filled spaces such as the sinuses and the brain, it can lead to bacterial meningitis. In such cases, surgical repair of the dura mater is required to restore a protective barrier.

Bone or ligament injuries of the spine can occur as a result of external trauma to the axial skeleton, such as traffic accidents or falls. If the spinal cord or nerves are also damaged, this can lead to severe neurological deficits, including paralysis, unless rapid surgical decompression is performed to relieve pressure on the spinal cord or nerve roots. The main feature of a spinal cord injury is a defined level of damage, above which neurological function is preserved and below which function is lost or significantly impaired.

The classification into stable or unstable vertebral fractures is important in determining whether surgical intervention is required or if conservative, non-surgical treatment is possible. 

  • Unstable spinal injuries are diagnosed when the bony and ligamentous integrity of the spine is so compromised that free movement can compress the spinal cord or its blood supply, causing severe pain and potentially major deterioration in neurological function. In such cases, internal stabilization of the spine is achieved through neurosurgical operative procedures.
  • Stable spinal injuries can often be treated conservatively with pain management and physiotherapy. Immobilization of the affected spinal segment, for example using a brace, usually provides significant pain relief.