Surgical Management of Severely Head Injured Patients

  • F. Servadei
  • M. T. Nasi
  • G. Giuliani
Conference paper


The prognostic factors in severe head injury are firstly the age, the degree of coma and the pupillary status.


Cerebral Perfusion Pressure Subdural Hematoma Epidural Hematoma Severe Head Injury Comatose Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Teasdale GM, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84PubMedCrossRefGoogle Scholar
  2. 2.
    Marshall LF, Gautille T, Klauber MR et al (1991) The outcome of severe closed head injury. J Neurosurg 75: S28–S36Google Scholar
  3. 3.
    Marion DW, Carlier PM (1994) Problems with initial Glasgow coma score assessment caused by the prehospital treatment of head-injured patients: results of a national survey. J Trauma 36: 89–95PubMedCrossRefGoogle Scholar
  4. 4.
    Gennarelli TA, Spielman GM, Langfitt TW et al (1982) Influence of the type of intracranial lesion on outcome from severe head injury. A multicenter study using a new classification system. J Neurosurg 56: 26–32PubMedCrossRefGoogle Scholar
  5. 5.
    Lobato RD, Rivas JJ, Cordobes F et al (1988) Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma. J Neurosurg 68: 48–57PubMedCrossRefGoogle Scholar
  6. 6.
    Phonprasert C, Suwanwela C, Hongsaprabhas C et al (1980) Extradural hematoma: analysis of 138 cases. J Trauma 20: 679–683PubMedCrossRefGoogle Scholar
  7. 7.
    Reale F, Delfini R, Mencattini G (1984) Epidural hematomas. J Neurosurg Sci 28: 9–16PubMedGoogle Scholar
  8. 8.
    Poon WS, Li AKC (1991) Comparison of management outcome of primary and secondary referred patients with traumatic extradural haematoma in a neurosurgical unit. Injury 22: 323–325PubMedCrossRefGoogle Scholar
  9. 9.
    Mendelow AD, Karmi MZ, Paul KS et al (1979) Extradural haematoma: effect of delayed treatment. Br Med J 1: 1240–1242PubMedCrossRefGoogle Scholar
  10. 10.
    Seelig JM, Marshall LF, Toutant SM et al (1984) Traumatic acute epidural hematoma: Unrecognized high lethality in comatose patients. Neurosurgery 15: 617–620PubMedCrossRefGoogle Scholar
  11. 11.
    Bricolo AP, Pasut ML (1984) Extradural hematoma: Toward zero mortality. A prospective study. Neurosurgery 14: 8–11PubMedCrossRefGoogle Scholar
  12. 12.
    Servadei F, Vergoni G, Staffa G et al (1995) Extradural haematomas: how many deaths can be avoided? Protocol for early detection of hematoma in minor head injuries. Acta Neurochir (Wien) 133: 50–55CrossRefGoogle Scholar
  13. 13.
    Teasdale GM, Galbraith S, Murray L et al (1982) Management of traumatic intracranial haematoma. Br Med J 285: 1695–1697CrossRefGoogle Scholar
  14. 14.
    Servadei F, Piazza G, Serrachioli A et al (1988) Extradural haematomas: an analysis of the changing characteristics of patients admitted from 1980 to 1986: Diagnostic and therapeutic implications in 158 cases. Brain Injury 2: 87–100PubMedCrossRefGoogle Scholar
  15. 15.
    Jennet B, Bond M (1975) Assessment of outcome after severe brain damage: A practical scale. Lancet 1: 480–484CrossRefGoogle Scholar
  16. 16.
    Bullock R, Smith RM, Van Dellen JR (1985) Non operative management of extradural hematoma. Neurosurgery 16: 602–606PubMedCrossRefGoogle Scholar
  17. 17.
    Servadei F, Faccani G, Roccella P et al (1989) Asymptomatic extradural hematomas. Acta Neurochir (Wien) 96: 39–45CrossRefGoogle Scholar
  18. 18.
    Sakai H, Takagi H, Ohtaka H et al (1988) Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure. J Neurosurg 68: 566–570PubMedCrossRefGoogle Scholar
  19. 19.
    Seelig JM, Becker DP, Miller JD et al (1981) Traumatic acute subdural hematoma. Major mortality reduction in comatose patients treated within four hours. N Engl J Med 304: 1511–1518PubMedCrossRefGoogle Scholar
  20. 20.
    Kotwica Z, Brzezinski J (1993) Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 121: 95–99CrossRefGoogle Scholar
  21. 21.
    Stone JL, Lowe RJ, Jonasson O et al (1986) Acute subdural hematoma: direct admission to a trauma center yields improved results. J Trauma 26: 445–450PubMedCrossRefGoogle Scholar
  22. 22.
    Wilberger JE, Harris M, Diamond DL (1991) Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 74: 212–218PubMedCrossRefGoogle Scholar
  23. 23.
    Yanaka K, Kamezaki T, Yamada T et al (1993) Acute subdural hematoma: prediction of outcome with linear discriminant function. Neurol Med Chir (Tokyo) 33: 552–558CrossRefGoogle Scholar
  24. 24.
    Servadei F, Nanni A, Nasi MT et al (1995) Evolving brain lesion in the first 12 hrs after head injury: analysis of 37 comatose patients. Neurosurgery 37: 899–907PubMedCrossRefGoogle Scholar
  25. 25.
    Wong CW (1995) Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta Neurochir (Wien) 135: 38–43CrossRefGoogle Scholar
  26. 26.
    Bullock R, Teasdale G (1990) Surgical management of traumatic intracranial hematomas. In: Braakman R (ed) Handbook of clinical neurology: Head injury. Elsevier Pub, New York, pp 249–298Google Scholar
  27. 27.
    Ranshoff J, Benjamin MV, Gage EL et al (1971) Hemicraniectomy in the management of acute subdural hematoma. J Neurosurg 34: 70–79CrossRefGoogle Scholar
  28. 28.
    Cooper PR, Rovit RL, Ranshoff J (1976) Hemicraniectomy in the treatment of acute subdural hematoma: a re-appraisal. Surg Neurol 5: 25–28PubMedGoogle Scholar
  29. 29.
    Tokutomi T, Shigemori M, Kikuchi N et al (1992) Treatment of acute subdural hematoma. In: Nakamura N, Hashimoto T, Yasue M (eds) Recent advances in neurotraumatology. Springer, Tokyo, pp 367–370Google Scholar
  30. 30.
    Soloniuk D, Pitts LH, Lovely M et al (1986) Traumatic cerebral hematomas: timing of appearence and indications to operative removal. J Trauma 26: 787–793PubMedCrossRefGoogle Scholar
  31. 31.
    Yamaki T, Hirakawa K, Ueguchi T et al (1990) Chronological evaluation of acute traumatic intracerebral haematomas. Acta Neurochir (Wien) 103: 112–115CrossRefGoogle Scholar
  32. 32.
    Mathiesen T, Kakarieka A, Edner G (1995) Traumatic intracerebral haematoma in 218 patients. Acta Neurochir (Wien) 137: 155–163CrossRefGoogle Scholar
  33. 33.
    Sakas D, Bullock R, Patterson J et al (1995) Focal cerebral hyperemia after focal head injury in humans: a benign phenomenon? J Neurosurg 83: 277–284PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 1998

Authors and Affiliations

  • F. Servadei
  • M. T. Nasi
  • G. Giuliani

There are no affiliations available

Personalised recommendations