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Abstract
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Life-saving extracranial damage control surgery in severe TBI patients
First, it would be good to know whether extracranial surgeries were carried out less than 24 h following trauma [7]. Given that severe TBI patients first and foremost need neuroprotective care [8], any extracranial surgery for non-life-threatening trauma lesion should be delayed for a few days according to neurosurgery damage-control principles [4], [5], [8], [9]. Nevertheless, in my opinion carrying on life-saving or simply important trauma surgeries should not be discouraged in the acute...
Massive transfusion protocol for severe trauma patient with concomitant severe TBI
How many TBI patients in the extracranial surgery group did suffer from intraoperative hemorrhagic shock? In such case, what was the authors' massive transfusion protocol [13], and was exsanguination taken into account as a potential confounding factor of long-term neurological outcome [14], [15]?...
Invasive intracranial pressure monitoring in severe TBI patients undergoing emergency extracranial surgery
Did severe TBI patients with intracranial trauma lesions on the brain CT scan undergo intraoperative monitoring of intracranial pressure, which can be achieved either using invasive intracranial pressure monitoring device or continuous trans-cranial doppler, during extracranial surgery in a systematic manner, according to guidelines [6], [16], [17]?...
Diffuse axonal injury and posttraumatic chronic encephalopathy
Even in the CT negative mild TBI group, extracranial surgery negatively impacted long-term neurological prognosis. Was brain MRI systematically performed looking for diffuse axonal injury, and was the presence of diffuse axonal injury included as a potential confounding factor for long-term neurological outcome [7]?
Going further, some diffusion-positive white matter tracts injury may not be visible on conventional MRI [18], but may be responsible for posttraumatic chronic encephalopathy in the...
Extracranial life-saving surgery in severe TBI patients: where do we stand?
This study's results should be interpreted with caution [7]. Indeed, they go against previous evidence showing that elective emergency extracranial procedures may be safely performed in severe TBI patients with proper monitoring of intracranial pressure, among other things [4], [5], [6], [11], [12]. Nevertheless, these results raise important concerns, highlighting possible side effects of life-saving extracranial surgeries in severe TBI patients if improperly conducted. They call for further...
Conclusion: combined life-saving cranial and extracranial surgery
This being said, emerging evidence points toward the possibility of performing extracranial procedures quite safely whenever it is absolutely required in the acute setting for severe TBI patients, for as long as intracranial pressure is relieved and properly monitored, and secondary brain injuries prevented and treated [5], [6], [11], [12], [22]. Besides, the current paradigm shift from emergency extra-cranial hemostatic surgery to embolization, with the use of a dedicated hybrid operating room
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