Traumatic Brain Injuries
Traumatic brain injuries are still a significant public problem across the world. In United States of America, each year 1.4 million people are exposed to brain injury. 1/3 of all death cases are caused by traumatic brain injuries. According to State Institute of Statistics, in our country, total accidents involving death and injury is 96,128 in 2016, and 4,633 people died and 169,080 people were injured. According to the researches carried out in last 30 years, it has been revealed that intense and specific treatment programs reduce disability and death in traumatic brain injuries. However, despite intense treatment, most of traumatic cases remain disabled for a long time or die. Even in cases having experienced moderate brain injury, significant neurophysiological and psychiatric damages may remain. Main target in the treatment of traumatic brain injuries is to prevent secondary damages. Secondary damages mean cerebral edema observed after trauma, decrease in blood flow in the brain, increased intracranial pressure and as a result, continue of the brain damage to increase after brain injury. Unfortunately, today, treatments are applied just to decrease secondary damages, brain cells damaged in an unrecoverable way during injury cannot be treated. Brain injuries can be classified under three main titles as mild, moderate and severe. Classification of a patient having brain injury is made according to a scoring system called Glasgow Coma Scale (GCS) and showing consciousness status of the patient. Brain injuries-dependent lesions can be classified under two main topics. These are focal (in a specified area) lesions and diffuse (wide) lesions.
Epidural Hematom (Hemorrhage)
This hemorrhage occurs between the membrane surrounding the brain (dura) and parietal bone, and is not directly related to the brain. However, it ma compress and damage the brain in the event that it continues and grows. It consists less than 1% of all brain injuries. Generally, it occurs when edges of fractures cut the veins on the dura. Sometimes, it may occur due to the bleeding of edge of the fractures. Rarely, it may be caused by vena cava of the brain. If it is treated early, results will be very successful. Because, its damage to the brain is restricted. Results after the operation are related to the neurological tables (Glasgow Coma Scale) of the patients before the operation. In other words, in patients undergone to operation with bad consciousness, risk of disability is higher. In some patients, bleeding amount does not require operation and the patient is followed-up closely at the hospital. Some patients are immediately operated. During the operation, parietal bone in the area where hemorrhage is present is lifted, hemorrhage is cleansed and source of the hemorrhage is stopped. Lastly, lifted parietal bone is placed, fixed and the operation is terminated.
Subdural Hematoma (Hemorrhage)
This hemorrhage occurs between brain membrane (dura) and brain. In other words, hemorrhage directly contacts the brain. It is seen more than epidural hematom. In particular, it is seen in the cases with severe brain injury by 30%. Generally, hemorrhage occurs due to break off bridge veins between the brain and brain membrane (dura) at the moment of trauma. If the trauma is very severe, in that case it may be related to the bleeding of the damaged brain tissue. Sometimes (in advanced age, in those using alcohol, patients using blood thinners), subdural hematoma may develop even after months after mild impact to the head. This is called chronic subdural hematoma. Results of acute (developed right after the trauma) subdural hematoma are worse than the results of epidural hematom. One of the reasons of this is that this hemorrhage cases are generally seen together with brain injuries. High death rate in subdural hematoma can be decreased with instant surgical intervention and aggressive intensive care treatment. Subdural hematoma surgery is similar to epidural hematom surgery. The difference is that as the bleeding occurs under the brain membrane, this membrane is also lifted and the bleeding is discharged. In other words, the brain is directly contacted. This increases the risk of complication of the operation.