Chapter 5.

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SURGICAL TREATMENT

Note:
Nothing.

Contents:
5.1.: Intracranial haematomas
5.2.: Skull fractures
5.3.: Decompressive craniotomy
5.4.: Timing of extracranial surgery

STANDARD 5.1.: INTRACRANIAL HAEMATOMAS Hvezdicka.GIF (147 bytes)Hvezdicka.GIF (147 bytes)

Epidural haematomas or acute subdural haematomas should be evacuated as soon as detected. For small haemorrhagic contusions and other small intracranial lesions that are not causing the mass effect, we prefer non-surgical treatment.

Commentary:
5.1.1. Specific indications for intracranial traumatic leasons operation
         

STANDARD 5.2.: SKULL FRACTURES Hvezdicka.GIF (147 bytes)

Patients with depressed skull fractures should be operated on if the fracture is open or big enough to cause the mass effect. Closed depressed skull fractures only require non-operative treatment.

Operations for skull base fractures are postponed. The aim is to control CSF leakage and to prevent post-traumatic meningitis.

STANDARD 5.3.: DECOMPRESSIVE CRANIOTOMY Hvezdicka.GIF (147 bytes)

Decompressive craniotomy can be useful for the management of intractable intracranial hypertension.

STANDARD 5.4.: TIMING OF EXTRACRANIAL SURGERY Hvezdicka.GIF (147 bytes)

Management of life-threatening injuries to the chest and abdomen causing haemorrhagic shock has priority over intracranial surgery. Accordingly, major blood loss due to fractures or vascular injuries is a priority.

There is no consensus on timing elective orthopedic or maxilofacial operations for cases without life-threatening extracranial injuries.

We perform spinal surgery with delay.

Commentary:
5.4.1. Extracranial surgery timing  
         

Coordinated by Jaroslav PLAS, M.D. Ing.

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Last updated: 2000-08-04