Surgical Treatment

Brain surgery is a procedure to treat problems in the brain and the surrounding structures. After initial treatment and acute treatment are administered to a brain injury victim, doctors may decide if surgical treatment is necessary.

The primary aim of surgical treatment on a brain injury is to prevent further injury by maintaining blood flow and oxygen to the brain and reducing swelling as well as pressure on the brain and skull. Pressure on the brain occurs when the brain tissue swells and is compressed against the skull. Because the skull can’t expand, blood is prevented from its full circulation and the brain cells become permanently damaged. Brain surgery, in some cases, can remove the pressure thus preventing further damage.

In an open head injury, surgery may be called for to remove damaged tissues and to repair skull fractures.

In a closed head injury, surgery may be required for various reasons:

  • A bolt or intracranial pressure (ICP) monitoring device may be surgically inserted in the skull for the purpose of monitoring pressure in the brain cavity.  
  • Bleeding blood vessels or blood clots may be surgically drained, removed, or repaired.
  • Damaged brain tissue may be surgically removed in cases of widespread swelling, to give room for the healthy brain cells.

A craniotomy is a surgical procedure where doctors open the skull to gain access to the brain for repairing the damage from the trauma. Surgical treatment for brain injury will be performed immediately in cases of hemorrhage and epidural hematomas, or surgery may be called for hours or days later as with subdural hematomas. In general, the need to reduce intracranial pressure and remove blood clots is the most immediate indications for surgery. If the pressure is increasing due to the swelling of the brain tissue, it must be treated quickly and aggressively since brain edema (swelling) can produce additional, more severe, brain injury.

After surgery, the patient will be closely monitored by the health care team to make sure that the brain is working properly. The brain injury patient is placed in intensive care and may be attached to a ventilator. The doctors will keep the patient asleep so the brain can begin to heal.

The advantage of being on a ventilator is that the doctors can more easily monitor levels of oxygen and carbon dioxide and make necessary adjustments. The intracranial pressure needs to be closely monitored after surgery to be sure there aren’t complications like swelling or bleeding that would cause the pressure to increase.