Evacuation of traumatic intracerebral haematomas using a simplified stereotactic procedure

Neuro damage control: current concept and civilian applications

Damage control (DC) initially referred to abbreviated (<1 h) surgical procedures to control abdominal hemorrhage in severe trauma patients, to avoid the 'bloody vicious circle' of hypothermia-coagulopathy-acidosis-hypocalcemia. Progressively, the concept was extended to pre-hospital and peri-operative surgical and non-surgical trauma care. The DC strategy can be applied either in a single severe trauma patient at risk of progression toward the bloody vicious circle or in case of limited or overwhelmed health resources (deprived environment, mass casualties, etc.). DC strategies in neurological casualties have improved over the last decade in military neurosurgeons, but remain poorly codified in civilian settings. In this comprehensive review, we summarize the current concept of neuro-DC, which includes surgical and medical care for neurological injuries as part of a DC strategy. Neuro-DC basically consists in: (i) preventing secondary brain injury; (ii) controlling intracranial bleeding; (iii) controlling intracranial pressure; (iv) limiting contamination of compound wounds; and (v) achieving secondary anatomical restoration.

Surgical Management of Traumatic Parenchymal Lesions

RECOMMENDATIONS (see Methodology)

Indications

Timing and Methods

[Craniotomy guided by computed tomography with three dimensional reconstruction: technical note]

OBJECTIVE

Searching usefulness of computed tomography with three dimensional reconstruction in planning accurate cranial approaches to treat subcortical lesions.

METHOD

Eight patients with neoplastic subcortical convexity-based lesions were surgically treated following spatial coordination obtained with three dimensional computed tomography reconstruction (CT 3D).

RESULTS

Accurate approaches were accomplished, allowing a safe and optimized removal of neoplasms in all cases.

CONCLUSION

The study manifests the benefits of CT 3D in planning suitable craniotomies, avoiding incongruous approaches.