[Management of Severe Traumatic Brain Injury]

In the management of traumatic brain injury (TBI), even when the injury initially appears isolated to the head, occult injuries may be present; therefore, a comprehensive evaluation in accordance with the Japan Advanced Trauma Evaluation and Care is essential. Traumatic coagulopathy is frequently observed in patients with TBI, particularly in severe cases. In addition, the aging population has increased in recent years, and many elderly patients are taking antithrombotic medications. Patients with a tendency to bleed may develop severe symptoms due to hematoma growth or challenging surgical hemostasis, necessitating appropriate perioperative measures. Traditionally, large craniotomies were performed to achieve adequate hemostasis and decompression. However, mini-craniotomy combined with neuroendoscopy has recently been adopted to minimize surgical invasiveness, particularly in elderly patients. Postoperative management focuses on visualizing intracranial pathology through neuromonitoring and implementing neurocritical care to prevent secondary brain injury through optimal systemic management. Although the number of severe TBI cases has decreased in recent years and opportunities for clinical experiences may be limited, understanding the fundamental principles of severe TBI management remains essential for neurosurgeons.