Individual traumatic brain injury therapy depending on severityHow a traumatic brain injury is treated depends crucially on the severity of the trauma. For example, in the case of a minor traumatic brain injury, any headache or neck pain that occurs can be alleviated by medication or physiotherapy. Severe trauma often results in swelling of the brain and/or bleeding, which may require surgery.
Conservative treatment methods
Traumatic brain injury: Treatment for minor trauma
People over 65 years of age and patients with a blood clotting disorder are considered high-risk patients. An unclear sequence of events during the accident or the detection of a skull fracture are also always risk factors.
In all these cases, the patient should be observed in hospital for at least 24 hours because many patients with minor traumatic brain injury develop what is known as post-traumatic syndrome. Its symptoms consist of dizziness, nausea, head and neck pain, exhaustion, depressive moods, and hypersensitivity to light and sound. The therapy is carried out using medication, painkillers, physiotherapy and relaxation methods. In about 10 per cent of cases, the symptoms persist for longer, possibly for up to a year. This is referred to as chronic post-traumatic syndrome. In addition to psychosocial care, treatment with antidepressants can also be administered here.
Surgical treatment methods
Traumatic brain injury: Therapy for severe or moderate trauma
Patients with a severe traumatic brain injury must be monitored and artificially ventilated in the intensive care unit. Oxygen deficiency and drops in blood pressure should thus be avoided. The further procedure depends on the findings of the imaging procedures on the brain. In particular, brain pressure therapy and the question of whether a neurosurgical intervention is necessary take priority.
Patients with a moderate traumatic brain injury must be admitted to a special monitoring ward. In the case of severely impaired consciousness, half of the patients already show a pathological finding in a CT scan. A neurosurgical intervention is necessary in almost 30 per cent of these cases.
Brain pressure must be monitored for unconscious patients, which involves inserting a brain pressure probe. If the pressure inside the skull rises sharply due to swelling of the brain or bleeding, the brain can no longer be supplied sufficiently with blood and thus with oxygen. In this case, an operation is required to provide relief. This can be performed by removing parts of the skullcap in combination with widening the hard meninges (decompressive craniectomy).
If cerebrospinal fluid accumulates during the acute phase, an external cerebrospinal fluid drainage system must be fitted. If this problem does not return to normal, what is known as a shunt system can be useful to reduce brain pressure to a normal level.
When the patient has recovered from the trauma and the swelling of the brain has decreased, the skullcap can be reconstructed. CAD-milled cranial bone replacements made from fibreglass or titanium are used here in order to achieve a good cosmetic result and to keep the risk of infections to a minimum.