Five decades of head injury care – a neurosurgeon’s perspective

Abstract

Successive wars in Europe and the Far East have taught neurosurgeons the importance of early wound debridement after open head injury to minimise infection even since the availability of antibiotics. Recognition of the importance of secondary brain damage due to systemic hypoxia and hypotension and raised intracranial pressure was the first major post-war development, leading to intensive medical treatment of patients in coma. The Glasgow Coma and Outcome Scales facilitated multi-centre data collection to study the effectiveness of such treatment. In the mid-1970s CT scanning led to earlier detection and treatment of acute intracranial haematomas, with improved outcomes. Pharmacological agents to prevent or control secondary pathological processes in the brain have so far proved disappointing. Epidemiological studies indicate different causes for mild and severe injuries and indicate how to target preventive measures. Severe head injuries due to road accidents are now less common in developed countries due to legislation to reduce accidents and to protect the brain in accidents. Co-ordinated rehabilitation is an important recent development in improving outcome after severe head injury.