Head injuries range from minor bumps at the slight end to serious traumatic brain injury at the severe end. It is, therefore, very important to understand when surgery will be necessary for proper treatment and recovery.

Below is a blog explaining in simple terms when surgical intervention is needed for head injuries.

Understanding Head Injuries

They are injuries to the skull, scalp, or brain. Most of the time, head injuries are caused by falls, traffic accidents, sports injuries, and assaults. In this respect, the symptoms range from very mild headache and dizziness if the injury is slight to a complete knock-out and amnesia in severe injuries.

Types of Head Injuries

Concussions: Concussions are the mildest form of TBI, which is generally caused by a blow or jolt to the head. They usually cause only temporary confusion, headaches, and dizziness. Surgery is rarely needed for concussions; however, keeping a watchful eye on conditions and merely resting are advised.

Contusions: Contusions are bruises on the brain, usually caused by direct impact. Small contusions may well heal by themselves; larger ones can cause significant brain swelling and sometimes need surgery to reduce pressure.

Skull Fractures: With skull fractures, the bone will often crack or even break. Simple fractures might not require surgical procedures, however depressed fractures—which mean the pressure of the bone piece onto the brain—more often than not may be treated surgically to prevent further damage and infection.

When Surgery Is Necessary

Severe Brain Swelling: If there is a head injury that results in very bad swelling of the brain, this may increase pressure and thus cause some damage to the tissues in the brain. Other times it requires surgery to be performed by removing part of the skull, as in decompressive craniectomy, so that the brain can swell up without compression.

Persistent Bleeding: Surgery may be necessary in case of persistent bleeding or large-scale bleeding in the brain or its outer cover to stop the bleed and to remove the accumulated blood. This is very important in the prevention of further damage to the brain tissue and relieves pressure.

Skull Fractures with Complications: Such complicated skull fractures, especially where the bone fragments project into the brain or create open wounds, call for surgical intervention. The measures may be surgical fixation of the skull, removal of bone fragments, and prevention of infection.

The Surgical Procedures

Craniotomy: The approach involves the removal of a part of the skull to access the brain. Surgeons can then remove blood clots, repair damaged tissue, and alleviate pressure. The bone flap needs to be replanted in its original anatomic position after the procedure.

Decompressive Craniectomy: In more advanced cases of swelling, decompressive craniectomy is performed. A portion of the skull is removed with this procedure and allows the brain to enlarge in safety. The removed portion is usually stored and replaced once the swelling has gone down.

Burr Hole Drainage: In cases of small hematomas, a lesser invasive procedure of burr hole drainage may suffice. Small holes are drilled into the skull for drainage of accumulated blood and relief from pressure.

Recovery and Rehabilitation: Recovery from surgery is carefully monitored and managed within the intensive care unit. Rehabilitation could be essential and may include physical, occupational, and speech therapy if functional deficiencies occur or are pre-existing. It is normally a long troublesome recovery, requiring help from health experts or even family members.

Conclusion

Knowing the types of injuries to the head and when surgery is needed helps in making decisions regarding treatment and recovery. In case you or a member of your family has suffered an injury to your head, seek immediate medical attention to obtain advice on how to proceed.

Dr. Naresh Kumar Damesha
Consulting Neurosurgeon