Medical Personnel
What is a Neurosurgeon?
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The neurosurgeon plays an important role in the treatment of Traumatic Brain Injury (TBI) especially in the early phases.
The initial treatment of persons with TBI has significantly improved over the last 20 years, particularly from the standpoint of emergency medical treatment in the field or prior to hospital arrival. With pre-hospital stabilization and resuscitation, we have seen improved outcomes. In most centers that treat traumatic head injury, a team of physicians administer patient care from the beginning. These may include the emergency room physician (the first contact for the ambulance personnel), a trauma surgeon, a critical care physician, and most always an orthopedic surgeon and a neurosurgeon.
The medical team approach is appropriate because most persons with moderate to severe head injury also have other significant injuries to the lungs, internal organs or long bones. All of the injuries have to be addressed as they are recognized. For the most part, the injury incurred at the time of impact, referred to as primary injury, cannot be reversed. The secondary phase of brain injury or the effects of pressure on the brain from external sources such as blood clots or depressed fractures or internal swelling, are problems that can be addressed on an emergency basis and may allow changes in anticipated outcome. A neurosurgeon is one of the specialists who may be consulted at this point.
The initial neurological exam is an important predictor for the degree of recovery to expect. For example if the patient is deeply comatose at the time of the accident, the likelihood for complete recovery is decreased. One of the most useful tests is a CT scan of the head. This study can show injuries such as bleeding in or around the brain, skull fractures, or brain swelling. The sooner pressure on the brain can be relieved, the better the chance for recovery. Several different approaches can be used simultaneously, including: diuretics to pull fluid from the brain through the kidneys; placing the patient on a breathing machine, which also “shrinks” the brain to some degree; removing blood clots from in or around the brain.
A neurosurgeon is often part of the medical team that helps determine whether or not the patient’s condition requires surgical intervention, such as inserting a brain monitor or performing a craniotomy (a procedure to open the skull and remove blood clots). Clots may be epidural, outside the covering of the brain; subdural, on the surface of the brain; or intracerebral, in the substance of the brain. If brain swelling is severe, a portion of the skull may be removed and placed in the laboratory freezer to be returned to its anatomical site when the swelling subsides. A monitor may be placed into the brain, or in a fluid space in the brain, to allow continuous monitoring and treatment of pressures. This is important in preventing a secondary injury from brain swelling.
After surgery, the person is typically cared for in the intensive care unit. It may be days, weeks or even months before the injury outcome is known. As the person recovers, other members are added to the team including speech therapist, physical therapists and occupational therapist. As the person’s condition progresses, a rehabilitation doctor becomes more involved to guide the return to functional recovery.
Florence C. Barnett, MD is a neurosurgeon in private practice in Roswell, Georgia. She attended the Medical College of Georgia in Augusta, Georgia. Subsequently she studied trauma surgery and critical care at Carraway Methodist Medical Center in Birmingham, Alabama for 2 years before completing a Neurosurgical residency at the Medical College of Georgia. She is a member of the American Association of Neurological Surgeons, Neurotrauma and Critical Care section and has special interest in the treatment of traumatic brain and spinal cord injury.