Kids and Treatment for Severe Traumatic Brain Injury
Jun 29, 2017
From the age of five through adulthood, trauma is the leading cause of death, and many traumatic injuries involve brain injury. Fortunately, the majority of traumatic brain injuries are mild, but nevertheless, some children will experience a severe traumatic brain injury. Severe traumatic brain injury is a brain injury so bad that it causes the individual to have a low level of brain function immediately following the trauma.
When a severe traumatic brain injury is identified, clinicians move quickly to ensure that the patient is able to breathe and has sufficient blood flow to the brain. These steps are taken because the primary risk of a traumatic brain injury is that the brain will not receive enough oxygenated blood, which could lead to further brain damage. This often will include placement of a breathing tube. Once the patient is stable, the next steps are to identify what type of brain injury has occurred. Imaging should be done to examine the skull, spine, brain, and spinal cord.
Frequently, children who have experienced a severe traumatic brain injury will require a brain pressure monitor. These monitors are placed by drilling a small hole in the skull and inserting the monitor. One type of monitor is an intraparenchymal monitor which is a metal wire that is passed into the brain tissue. The other main type is an external ventricular drain; this is a soft silicone tube that is passed into the brain ventricle and used to monitor pressure, and lower pressure, by draining cerebrospinal fluid.
Sometimes patients will have a traumatic brain injury that causes a blood clot to form, putting pressure on the brain. These patients may need a surgery called a craniotomy to remove the blood clot and reduce brain pressure. Occasionally, the brain is injured so severely that massive swelling is caused. This may require the surgeon to remove a portion of skull to give the brain more room to swell. This type of surgery is called a craniectomy.
Children who suffer a severe traumatic brain injury will require admission to a pediatric intensive care unit (ICU) for close monitoring and observation. Once patients are healthy enough to leave the ICU, they generally will be transferred to a hospital floor that specializes in taking care of children with neurological conditions where patients should receive more intense therapy (including physical, occupational, speech, music, recreation, and massage therapies). At the same time, cognitive rest, or brain rest, is used to allow for natural brain healing to occur.
It is not uncommon for severe traumatic brain injury patients to require inpatient rehabilitation before going home. This may be done at the hospital, so the neurosurgeon can continue monitoring your child’s progress. Once home, most patients will still require outpatient rehabilitation to maximize their recovery, and the neurosurgeon and rehabilitation doctors will continue to see your child as an outpatient.
While severe traumatic brain injury can certainly lead to permanent disability, with time and rehabilitation, many patients make remarkable recoveries.
Eric A. Sribnick, MD, PhD, is a pediatric neurosurgeon at Nationwide
Children’s and principal investigator in the Center for Pediatric Trauma
Research. He is also assistant professor of neurological surgery at The
Ohio State University College of Medicine.
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