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Understanding the Types of Surgery for Head Injury: What Are Your Options?

Side view of young female surgeon tying her surgical mask, discussing the types of surgery for head injury with her colleagues

In serious cases, patients will need emergency surgery after head injury to prevent further damage to the brain. Doctors have several surgical options to treat these problems.

You’re about to learn the types of surgery after head injury that a doctor might choose to perform. You will also learn which conditions require surgical intervention and which do not.

Conditions That Require Surgery After Head Injury

Besides damage to the brain itself, certain head injuries can lead to severe complications that have life-threatening effects.

Some of these complications, such as infections, can be treated with medications. But some will demand emergency surgery.

Conditions that require surgery after head injury include:

  • Hydrocephalus. This occurs when cerebrospinal fluid (CSF) accumulates in the ventricles (cavities in the brain that produce CSF). The accumulation of fluid causes the ventricles to swell, which puts pressure on the brain and leads to further damage.
  • Skull fractures. These usually accompany penetrating brain injuries and can tear the protective covering on the brain. The tears can also allow bacteria and air into the brain, causing serious infections.
  • Intracerebral hemorrhages. Hemorrhages occur when an artery in the brain bursts, causing bleeding in the brain tissue. This is a life-threatening emergency that requires swift treatment to limit damage.
  • Hematomas. These are collections of blood that pool outside blood vessels. Hematomas can occur in the space between the skull and the outer layer of the brain, between the outer layer and the brain tissue, and within the brain tissue itself.

Most of these conditions require different types of surgery, which we will look at next.

Types of Surgery for Head Injury Complications

Surgery can help treat the conditions listed above. Most of these surgeries must be performed within a few hours after a head injury to prevent permanent damage.

The following are some types of surgery a doctor might use to treat head injury:

1. Craniotomy with Open Surgery

Concentrated surgeon performing craniotomy with her team

If a hematoma is large enough, the neurosurgeon will remove a section of the skull to drain the hematoma. This type of surgery for head injury is called a craniotomy.

A craniotomy also allows the brain, if it is swollen, to bulge out of the skull and reduce intracranial pressure. Reducing ICP is crucial for preventing further damage.

Once the hematoma is drained, the doctors can then directly operate on the brain to repair the broken blood vessels. This will stop further bleeding and swelling.

In addition, hematomas that are smaller than one centimeter can be treated with an aspiration procedure, a far less invasive surgery than a craniotomy.

During this procedure, your surgeon will drill a small hole called a burr hole into your skull. Then, the surgeon will place rubber tubes into the holes, which allow the blood from the hematoma to drain out.

2. Endoscopic Ventriculostomy

This type of surgery is primarily used to treat hydrocephalus, which causes an excess of cerebral spinal fluid in the brain.

During this procedure, your surgeon inserts a small video camera into your skull to see directly inside your brain. The surgeon then makes a hole in the bottom of one of your ventricles, which allows CS fluid to drain out of the brain.

A ventriculostomy can also be used to drain a hematoma that may have formed in one of your ventricles.

3. Ventriculoperitoneal Shunt Surgery (VPS)

VPS surgery is also used for hydrocephalus treatment. It involves the surgical insertion of a drainage system, called a shunt.

A shunt is a long, flexible tube with a valve at one end that drains fluid from the brain at a constant rate.

For the shunt to work properly, one end is placed in one of the brain’s ventricles, while the other end is tunneled under the skin to another part of the body, usually the abdomen. The spinal fluid then drains into the abdominal cavity, where it is absorbed by the body.

Most people with hydrocephalus will need a shunt system for the rest of their life and must be monitored regularly.

4. Decompressive Craniectomy

If intracranial pressure remains elevated and does not respond to medication, doctors will need to perform an emergency decompressive craniectomy.

Like the open craniotomy surgery discussed above, a craniectomy involves the removal of part of the skull. This gives the swollen brain room to expand without causing any more damage to it.

Surgeons also use craniectomies to remove open skull fractures, which prevents the fracture from penetrating the brain tissue.

These surgeries are risky, however, so doctors prefer to use them as a last resort. Other measures doctors might try before choosing a craniectomy can include:

  • Medication to decrease swelling
  • Oxygen therapy
  • Therapeutic hypothermia

They also might try aspirating the hematoma first to see if that helps. If the aspiration does not work, then they will go ahead with the craniectomy.

5. Cranioplasty

Finally, patients will usually have to undergo reconstructive surgery of their skull, also known as cranioplasty, after a head injury. These surgeries mostly occur after the person recovers from their craniectomy.

During a cranioplasty, the skull vault is repaired by inserting plastic or metal plates. Sometimes, if the damage was not too severe, the person’s own skull bone can be reinserted.

Cranioplasty helps the person avoid recurrent brain damage, protects them from seizures, and relieves trephine syndrome, which sometimes occurs after the removal of a large skull bone.

Signs and symptoms of trephine syndrome include:

  • Headaches
  • Intolerance of vibration and noise
  • Loss of motivation and concentration
  • Anxiety
  • Fatigue

Cranioplasty can also help increase cerebral blood flow and improve brain metabolism.

Recovery from Surgery After Head Injury

Most people who undergo brain surgery are already in critical condition because of their injury. Therefore, the length of their recovery depends on how severe their brain injury was.

Once they regain consciousness and recover from their surgeries, they should begin their TBI rehabilitation as soon as possible. Some therapies they might require include:

The more frequently they practice these therapies, the faster they will make a good recovery.

Types of Surgery After Head Injury: Understanding the Options

Surgery after a head injury can save a life if performed early enough. The type of surgery that your doctor will choose depends on the complications that occur after an injury.

For example, if your TBI causes a brain hemorrhage, your doctor might perform an open craniotomy to stop the bleeding. On the other hand, if the head injury triggered swelling, you may need a shunt or a craniectomy.

After the surgery, you will require prompt rehabilitation to ensure that you heal correctly. The sooner you begin therapy, the better chance you will have of making a full recovery.

Featured Images: ©iStock/gpointstudio/jacoblund

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