TRAUMATIC BRAIN INJURIES – SURGICAL MANAGEMENT AND OUTCOMES

Traumatic brain injury (TBI) is a major global health concern and a leading cause of mortality and long-term disability across all age groups. It results from external mechanical forces causing primary brain injury, followed by complex secondary injury cascades that exacerbate neuronal damage. TBI is classified based on pathophysiology, anatomical involvement, mechanism of injury, severity, and prognosis, each contributing to clinical decision-making and outcome prediction. Severity assessment relies primarily on the Glasgow Coma Scale, with supplementary tools such as the FOUR score and prognostic models like IMPACT aiding risk stratification. Management of severe TBI focuses on preventing secondary brain injury by maintaining cerebral perfusion and controlling intracranial pressure (ICP). While medical therapy is the first-line approach, surgical interventions remain central when ICP becomes refractory. Key surgical strategies include ventriculostomy, craniotomy for mass lesion evacuation, and decompressive craniectomy. Both primary and secondary decompressive craniectomy play critical roles in selected patients, though outcomes vary depending on timing, indication, and patient selection, as demonstrated by major clinical trials. Outcomes following TBI range from full recovery to severe disability or death and are influenced by injury severity, surgical intervention, and postoperative care. Optimal management requires individualized, evidence-based strategies that balance life-saving interventions with long-term functional outcomes.