May 27, 2024

Head injury describes a vast array of injuries that occur to the brain, skull, scalp, and underlying blood vessels and tissues in the head. Depending on the extent of the trauma, head injury is also called ‘traumatic brain injury (TBI).’ In moderate-to-severe TBI cases, emergency surgery helps to prevent any further damage to the brain. Also, a head injury can cause serious complications that have life-threatening effects.  

Conditions that require surgery for head injury

Mild complications like infections are treated with medications. However, serious complications may require surgery.

Here are some conditions that need surgery for a head injury. 

Skull fractures:
It is a break in the skull bone because of penetrating brain injuries. Skull fractures tear the brain’s protective covering, which further allows air and bacteria into the brain, causing severe infections. The four major types of skull fractures that need surgery include linear skull fractures, diastatic skull fractures, depressed skull fractures, and basilar skull fractures.

Hydrocephalus:
This condition occurs when cerebrospinal fluid (CSF) builds up in the ventricles (cavities that produce CSF) situated deep in the brain. The accumulation of fluid leads to swelling of the ventricles, which puts pressure on the brain and leads to further damage.

Intracerebral hemorrhage:
Hemorrhages are life-threatening emergencies that occur because of bleeding in the brain tissue. This requires immediate treatment to limit the damage as it deprives the brain of oxygen and blood supply.

Hematomas:
Hematoma is a collection of blood that accumulates outside blood vessels. It can occur in different locations in the brain. Intracranial hematomas (ICH) range from mild to potentially life-threatening head injuries. The various ICH include epidural hematoma, subdural hematoma, diffuse axonal injury (DAI), and contusion or intracerebral hematoma.

Types of surgery for head injury
Treatment of the conditions that require surgery after a head injury aids in saving a life. Depending on the traumatic brain injury complications, there are various types of surgeries to prevent permanent damage. 

Craniotomy with open surgery:
In case of a larger hematoma, your neurosurgeon will remove a part of the skull bone to expose the brain. In this type of surgery, the hematoma is drained using specialized tools. Once it is drained, the neurosurgeons directly operate on the brain and repair the damaged blood vessels to prevent further swelling and bleeding. A craniotomy surgery also helps the swollen brain to bulge out of the skull. This further aids in the reduction of intracranial pressure and prevents further damage. For smaller hematomas, an aspiration procedure is carried out, which is less invasive surgery. In this, your doctor drills a small burr hole in the skull and places rubber tubes to allow drainage of blood from the hematoma. 

Ventriculoperitoneal shunt surgery (VPS):
This surgical procedure is also used in the treatment of hydrocephalus. In this procedure, a surgical insertion is made to place a VP shunt to drain the extra CSF from the brain. A VP shunt is a long, flexible tube. It has a value at one end that drains excess fluid from the brain to the abdomen or under the skin at a constant rate. The body eventually absorbs the excess of spinal fluid.  

Endoscopic ventriculostomy:
It is used to treat hydrocephalus. In this procedure, the doctor inserts a small video camera into the skull to see directly inside the brain. Then the surgeon makes a burr hole in the third ventricle floor, which allows cerebrospinal fluid to drain out of the brain.

Decompressive craniectomy:
In some cases, the intracranial pressure remains elevated, and they need emergency decompressive craniectomy. This procedure involves removing part of the skull, allowing the swollen brain some room to expand, causing no further damage. As any brain surgery is risky, doctors prefer to use nonsurgical measures first like medication to decrease swelling, oxygen therapy, therapeutic hypothermia, etc.

Cranioplasty:
This is reconstructive surgery of the skull. It is carried out once the patient recovers from the craniectomy surgery. In this procedure, the surgeon inserts a plastic or metal plate and repairs the skull vault. This type of surgery helps the patient avoid any recurrent brain damage, relieves trephine syndrome, and protects from seizures. In addition, cranioplasty surgery helps to increase cerebral blood flow and improve brain metabolism.

Recovery from surgery

After the surgery, the traumatic brain injury patient needs prompt rehabilitation and support. This ensures proper healing. The length of the recovery depends mainly on the severity and location of the head injury. The recovery process typically progresses through different stages, including coma, confusion/amnesia, and recovery. 

Hence, after regaining consciousness from the surgery, rehabilitation and recovery should begin as soon as possible. Some therapies like speech therapy, occupational therapy, and physical therapy aids recovery after the head injury surgery.