Legacy: "Atlast of Neurosurgery" / L.Karaguiosov, A. Ramadan, K.Karaguiosov / Kiwait/ 1998
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2. Head Injury
In head injury, brain damage results from the initial impact (primary brain damage) and from the development of secondary complications (secondary brain damage). Cerebral contusion and laceration as well as diffuse injury of the brain parenchyma are the major components of the primary brain damage. Secondary brain damage is caused by intracranial haematomas, brain swelling and shifting, ischaemia or infection. The main goal of treatment is prevention or rapid treatment of secondary brain damage, and providing the patient with optimal conditions for recovery from the primary damage. The role of surgery consists of the urgent evacuation of traumatic mass lesions, relieving or preventing intracranial hypertension and brain shifts, repair of wounds and depressed skull fractures for prevention of infection, as well as at a later stage closure of CSF fistulae and cranioplasty. To be efficient, surgery in traumatic mass lesions must be really urgent and before the patient deteriorates and irreversible secondary brain damage appears. Intracranial pressure monitoring can be very helpful in the evaluation of indications for surgery and for the patient's prognosis.