Surgical Treatment for Traumatic Brain Injury: What to Expect

Common Surgical Procedures for Traumatic Brain Injury

Here we review the role of the neurosurgeon, indications for and types of surgical procedures performed to treat TBI. Neurosurgeons are specialized physicians with advanced training in the surgical management of conditions affecting the brain, as well as the spinal cord and their role in treating TBI includes assessing and managing acute intracranial hemorrhages, hematomas, contusions, and other traumatic brain injuries requiring surgical intervention.

Neurosurgery Procedures:

Neurosurgeons perform procedures to decompress the brain, remove blood clots or areas of damaged brain tissue (brain lesions), repair skull fractures, control bleeding, and alleviate intracranial pressure. Neurosurgeons collaborate with neurointensivists, neurologists, and other healthcare providers in the intensive care unit (ICU) to develop comprehensive treatment plans, monitor patients’ neurological status, and optimize outcomes through surgical and non-surgical interventions.

What to Expect Before, During, and After Surgery

According to the Cleveland Clinic and MedStar Health, depending on the type of surgery needed and the level of urgency involved, the patient and their family will need to be prepared for all of the following possible steps.

Preparing for Surgery:

• Undergo a physical exam, cognitive and breathing assessments, bloodwork, and imaging tests, including an X-ray, MRI, CT scan, PET scan, or angiography/arteriography
• Potentially avoid eating and stop taking medications (e.g., blood thinners)
• Potentially take antibiotics to ward off infection, anticonvulsants to protect against seizures, and diuretics to reduce fluid buildup
• Have their hair shaved and incision site cleaned

Recovering Right After Surgery:

Immediately after surgery, the patient will:

• Move to an intensive care unit where their vital signs, bleeding, swelling, and pain can be closely monitored and managed
• Remain hospitalized for several days or weeks while their condition continues to be monitored
• Rest while keeping their head upright instead of lying flat
• Receive instructions for at-home care when ready for discharge
• Attend follow-up appointments to ensure they’re healing as expected

Lingering effects from severe TBI cases

In some cases, patients recover from TBI and return to their normal level of health and activity over time. In other instances, however, there can be lingering effects from more severe TBI, which need to be evaluated and addressed on a case-by-case basis. They include:

• Cognitive Impairments — Problems may linger with memory, attention, and executive function.
• Behavioral Changes — A person with TBI may exhibit long-term increased irritability, impulsivity, or emotional instability that affect their personal and social relationships.
• Physical Challenges — A variety of chronic ailments can include motor deficits, coordination issues, and chronic pain.
• Educational Impact — Children with TBI may also have trouble with school performance and have a need for special educational programs and services.

Research from the TBI Model System program reveals the following average recovery rates for patients at 2 years after a moderate or severe injury:

• Most people can move around, bathe, and dress themselves without help; approximately 30% need some level of assistance from another person during the day, at night, or both.
• Trouble with thinking, processing speed, and forming new memories is common — although the severity of these issues varies.
• About 25% of patients have major depression. In some cases, it’s caused directly by the brain injury itself, in addition to dealing with major changes in their lives caused by the trauma, including employment, driving, and living circumstances.
• Just over 90% live in a private home. Of those who were living alone when they were injured, almost half continue to do so.
• About 50% of people can drive again, but there may be changes in how often or when they drive.
• About 30% of patients are employed, but it may not be at the same job they had before the injury. Many people get help from vocational rehabilitation counselors who help people with TBI and other disabilities to go back to work.

Caring for a Loved One with TBI?

While each injury, patient, and long-term outlook is different, there are some general guidelines that can help you and your family support a loved one through this emotional journey and achieve the best outcomes for all.