Neuro-Trauma Treatment Protocol

    
      Re: Neuro-Trauma Treatment Protocol
    


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Posted by CCF Neurosurgery MD on October 10, 1997 at 11:50:23:

In Reply to: Neuro-Trauma Treatment Protocol posted by Sarah Mitchell on October 08, 1997 at 11:14:13:

: Last night I was watching NOVA and they did a program about trauma procedures for head injuries.  During the program they showed incredible results when inserting a stent immediately following the injury.  While this protocol has been accepted and approved by the World Health Organization, the only US state to adopt this protocol is New York.  What are your thoughts regarding this protocol??
  Sarah
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Dear Sarah,
Head injuries are a major issue when dealing with the trauma patient population.
Patients with appropriate injuries will usually get an urgent CT scan of the head
to rule out any surgical lesions, such as epidural or subdural blood, which
can be evacuated.  Often there is significant head injury to cause swelling
of the brain, as with an injury to any other part of the body.  The problem
is that the brain is situated in a rigid cranial vault. The cranium will accomodate
swelling to a certain point, beyond which bad things happen.  The therapeutic
issue then becomes prevention of an increase in intracranial pressure (ICP).
One way to manage increased intracranial pressure is to insert a ventriculostomy
catheter.  This is simply a tube, which goes through a small hole drilled in
the skull, that rests in the ventricular system of the brain.  A ventriculostomy
allows the neurosurgeon two things: first he may measure the intracranial pressure,
and second he may choose to release some spinal fluid to relieve pressure from
swelling in the brain.  Another option is to insert a standard ICP monitor.  These
are devices that generally rest on or slightly in the brain and measure the
ICP.  They do not afford the therapeutic option of spinal fluid drainage.  
Notably, there are medical therapies that can be used to treat increased
ICP with either device that measures ICP.  
It sounds like the 'stent' you described from the NOVA show was a ventriculostomy
catheter.  Current literature and practice patterns favor a ventriculostomy
catheter over other ICP monitoring devices in severe head injury because of
the added therapeutic option of spinal fluid drainage.  If this is indeed
what you have described from the NOVA show, there is little question that
ICP monitors may be beneficial in cases of severe head injury.  
It isn't clear what trauma protocol you speak of from the show, so it is
difficult to answer why only New York has adopted such a protocol.  Let it
suffice to say that ICP monitors are accepted and commonly used devices in
the setting of severe head trauma.  Either device mentioned above is an
acceptable means to manage such cases.