NEUROSURGERY ARTICLES

Traumatic Brain Injury

Laura S. Paré, M.D.

Traumatic brain injury (TBI) is the leading cause of death and disability among young people in the U.S. Some of the brain damage that occurs is caused at the time of impact. Other brain damage occurs over the next few hours or days and is called secondary injury. Thirty years ago the rate of death from severe TBI was 50%. Now with advances in neurosurgery, the death rate for severe TBI has been reduced to 25%.

One of the most important complications of TBI is when a blood clot forms inside the head. Blood clots that form within the brain substance are called intracerebral hematomas. (Figure A) Blood clots that form on the outside of the brain but within the membrane that contains the brain (dura mater) are called subdural hematomas. (Figure B) Blood clots that form between the dura and the skull are called epidural hematomas. (Figure C)

If any of these blood clots are large enough to cause pressure on the brain, then the blood clot will be removed by a brain surgery known as a craniotomy. Up to 100,000 patients per year in the U.S. will undergo a craniotomy to remove a blood clot caused by trauma. Several studies have shown that the outcomes obtained for the care of patients with severe TBI can vary dramatically among different hospitals according to the level of commitment and expertise in neurotrauma. UC Irvine Medical Center is a designated Level 1 Trauma Center which means that it upholds the highest standards for the management of patients with severe TBI.

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