The management of severe head injury (SHI) remains a major challenge not only for neurosurgeons but also for all other health professionals involved in the care of trauma patients. Any trauma patient with SHI is at risk of further neurological deterioration if appropriate measures are not instituted from the start of his or her treatment. Secondary insults due to ischaemic, hypotensive, and metabolic or other causes are still common, even in the most advanced neurocritical care settings. Management controversies are widespread and few decision options can be supported by Class I evidence. This article attempts to provide an up-to-date review of the published recommendations that could help health professionals in their management of SHI.
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