Author/Editor		Strojnik, Tadej
Title		Odloženi operativni posegi pri poškodbah glave in možganov
Translated title		Delayed neurosurgical procedure in traumatic brain injury patients
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 1
Publication year		2003
Volume		str. I-75-8
Language		slo
Abstract		Background. Traumatic brain injury is a dynamic process and despite a normal initial CT scan of the head delayed intracranial haematoma which eventually requires surgical intervention may developed. Therefore careful monitoring of the patient with severe traumatic brain injury and repeated CT scans are mandatory. Patients and methods. In the paper we present basic characteristics of the delayed neurosurgical intervention in case of delayed intracerebral haematoma, epidural haematoma and subdural haematoma occurrence. Delayed neurosurgical treatment for the malignant intracranial hypertension, posttraumatic hydrocephalus, cerebrospinal fluid fistula and depressed fracture are also presented. Delayed neurosurgical intervention should be called every intervention that is performed as a result of a control CT scan. We suggest that a control CT scan should be done 8 hours after the initial CT scan and at least once again in the next 48 hours. Conclusions. When the traumatic brain injury patient is treated in a local hospital without neurosurgical care, the phone communication between the surgeon or anaesthesiologist in the local hospital and neurosurgeon is very important. It is mandatory that CT scans are also presented to the neurosurgeon. Because of lack of interest and bad outfit of the roentgen departments which does not allow direct transfer of images between RTG departments, we suggest scanning of images and sending them as email attachments. This would very much improve the communication and decision making. Hospitals that are not able to do so should not treat traumatic brain injury patients. Delayed neurosurgical intervention should be done by the neurosurgeon.
Summary		Izhodišča. Poškodba glave in možganov je dinamičen proces in tudi če je prvi CT posnetek normalen, se lahko že v nekaj urah razvije znotrajlobanjska krvavitev, ki lahko zahteva odloženi nevrokirurški poseg. Potrebno je skrbno spremljanje poškodovanca tako klinično kot tudi na osnovi meritev in ponavljati CT preiskavo. Metode. V pričujočem prispevku so predstavljene osnovne značilnosti odloženega nevrokirurškega posega pri intracerebralnem hematomu, epiduralnem hematomu in subduralnem hematomu. Predstavljene pa so tudi značilnosti odloženega nevrokirurškega zdravljenja pri neobvladljivi znotrajlobanjski hipertenziji in oskrbi popoškodbenega hidrocefalusa, likvorske fistule in impresijskega zloma. Predlagamo, da se za odloženi nevrokirurški poseg šteje vsak poseg, ki je opravljen na osnovi kontrolnega CT posnetka glave. Kontrolno CT preiskavo je potrebno opraviti po 8 urah po prvi, četudi normalni CT preiskavi glave in nato vsaj še enkrat v naslednjih 48 urah. Zaključki. V primeru, da se bolnik s hudo poškodbo glave in možganov zdravi v bolnišnici, kjer ni nevrokirurga, je potrebna telefonska komunikacija med lečečim kirurgom ali anestezistom iz lokalne bolnišnice in nevrokirurgom. Bistveno je, da ima nevrokirurg na voljo tudi CT posnetke. Zaradi slabe opremljenosti RTG oddelkov in/ali nezainteresiranosti je slike nemogoče posredovati direktno med RTG oddelki, zato predlagamo, da se jih posname z optičnim čitalcem in pošlje z elektronsko pošto. Na ta način bi lahko bistveno izboljšali medsebojno komunikacijo in skrajšali reakcijski čas. Menimo, da naj v bolnišnicah, ki niso sposobne zagotoviti vsaj takšnega posredovanja CT posnetkov, ne bi zdravili poškodovancev s hudo možgansko poškodbo. Praviloma sodi odloženi nevrokirurški poseg v roke nevrokirurga.
Descriptors		BRAIN INJURIES CEREBRAL HEMORRHAGE HEMATOMA, EPIDURAL HEMATOMA, SUBDURAL HYDROCEPHALUS TOMOGRAPHY, X-RAY COMPUTED CEREBROSPINAL OTORRHEA CEREBROSPINAL RHINORRHEA SKULL FRACTURES