Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results from a Multicenter Study.
OBJECTIVE
Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe TBI.


METHODS
Demographic, clinical, and radiologic data from a prospective national cohort study on severe brain-injured patients (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents [PEBITA]) were collected during a 3-year period. This study evaluated patients admitted to 7 of the 11 trauma centers included in PEBITA. We retrospectively analyzed surgery-related computed tomography (CT) findings prior to and after treatment, intracranial pressure (ICP) monitoring, size and technical features of craniotomy, as well as surgical complications. ResULTS: This study included 353 of the 921 patients enrolled in PEBITA who underwent surgical treatment for severe TBI. At admission, acute subdural hematoma was the most frequent focal lesion diagnosed (n = 154 [44%]), followed by epidural hematoma (n = 96 [27%]) and intracerebral hematoma (n = 84 [24%]). A total of 198 patients (61%) presented with midline shift. Clinical deterioration in terms of Glasgow Coma Scale scores or intractable ICP values as an indication for surgical evacuation or decompression were documented in 20% and 6%, respectively. A total of 97 (27.5%) only received a catheter/probe for ICP monitoring. Surgical procedures to treat a focal lesion or decompress the cerebrum were performed in 256 patients (72.5%). Of the 290 surgical procedures (excluding ICP probe implantation), craniotomy (137 [47.2%]) or decompressive craniectomy (133 [45.9%]) were performed most frequently. The mean size of craniectomy in terms of maximal linear width on the CT axial slice was 8.4 ± 2.9 cm. Intraoperative ICP monitoring was reported in 61% of the interventions. Significant intraoperative brain swelling was documented in 50.6% of the procedures. Surgery-related complications occurred in 89 cases (32%).


CONCLUSIONS
This study highlights the lack of standardized and systematic documentation of technical aspects of surgical treatment of patients presenting with severe TBI in Switzerland. Technical strategies such as size of craniectomy and the use of perioperative ICP measurement were not documented in a standardized manner. A prospective systematic surgical documentation system might contribute to future formulation of recommendations for the surgical treatment of patients presenting with severe TBI in Switzerland.
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Frédéric
F
Rossi-Mossuti
Department of Neurosurgery, University Hospital Basel, Basel, Switzerland.
Urs
U
Fisch
Department of Anaesthesiology, University Hospital Center of Lausanne, Lausanne, Switzerland.
Patrick
P
Schoettker
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Marinella
M
Gugliotta
Department of Neurosurgery, Hôpital du Valais, Sion, Switzerland.
Marc
M
Morard
Department of Neurosurgery, University Hospital Bern, Bern, Switzerland.
Philippe
P
Schucht
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Bawarjan
B
Schatlo
Department of Neurosurgery, University Hospital Center of Lausanne, Lausanne, Switzerland.
Marc
M
Levivier
Division of Anaesthesiology, University Hospital of Geneva, Geneva, Switzerland.
Bernhard
B
Walder
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
Javier
J
Fandino
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000601:surgery; D002675:Child, Preschool; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods / Q000706:statistics & numerical data; D023381:Endpoint Determination; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000601:surgery; D020199:Hematoma, Subdural, Acute / Q000601:surgery; D006801:Humans; D007427:Intracranial Pressure; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013557:Switzerland; D014057:Tomography, X-Ray Computed; D055815:Young Adult