Our Summary

This study looked at the reasons why some patients with traumatic brain injuries (TBI) need a second unplanned brain surgery, and what risk factors might predict this. The researchers studied 219 patients who had an initial surgery for their brain injury between 2016 and 2021. They found that the most common reason for a second surgery was a delayed or enlarged pool of blood (hematoma) in an area of the brain not originally operated on. Other causes included a return of the hematoma in the area that was operated on, a severe stroke, widespread brain swelling, and an enlarged brain bruise. They also found that patients who had a specific type of feature on their pre-op brain scans, which they called a “contralateral craniocerebral injury feature” (CCIF), were much more likely to need a second surgery on the opposite side of their brain. Overall, the main reason for a second unplanned surgery in TBI patients was a delayed or enlarged hematoma, and having a CCIF significantly increased the risk of needing a second surgery on the other side of the brain.

FAQs

  1. What was the most common reason for a second unplanned brain surgery in patients with traumatic brain injuries (TBI)?
  2. What is a “contralateral craniocerebral injury feature” (CCIF) and how does it impact the likelihood of a second surgery?
  3. What were the other causes for a second surgery, apart from a delayed or enlarged hematoma?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to closely monitor for any signs of complications, such as increased headache, confusion, weakness, or changes in vision. It is important to seek immediate medical attention if any concerning symptoms arise, as early intervention can greatly improve outcomes. Additionally, following post-operative care instructions, such as taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities, can help promote a successful recovery after a craniotomy.

Suitable For

Patients who are typically recommended for craniotomy include those with traumatic brain injuries, brain tumors, aneurysms, arteriovenous malformations, epilepsy, and other conditions that require surgical intervention in the brain. In the case of traumatic brain injuries, patients who have a delayed or enlarged hematoma, severe stroke, brain swelling, or brain bruise may require a craniotomy. Additionally, patients with specific features on their pre-op brain scans, such as the contralateral craniocerebral injury feature (CCIF), may also be at higher risk for needing a second surgery on the opposite side of their brain.

Timeline

  • Before craniotomy:
  1. Patient sustains traumatic brain injury (TBI) due to an accident or other trauma.
  2. Patient undergoes initial evaluation, imaging studies, and monitoring in the hospital.
  3. Neurosurgeon determines that a craniotomy is necessary to relieve pressure on the brain, remove blood clots, repair skull fractures, or address other issues.
  4. Patient undergoes pre-operative preparation, including blood tests, imaging studies, and anesthesia consultation.
  5. Patient undergoes craniotomy surgery, which involves removing a portion of the skull to access the brain and perform necessary procedures.
  6. Patient is monitored closely in the intensive care unit (ICU) post-surgery for any complications or changes in neurological status.
  • After craniotomy:
  1. Patient is closely monitored for signs of improvement or complications, such as infection, bleeding, or neurological deficits.
  2. Patient may require additional imaging studies, such as CT scans or MRI, to assess the brain’s healing and check for any new issues.
  3. Some patients may experience post-operative complications, such as seizures, cognitive deficits, or changes in personality.
  4. Patient undergoes rehabilitation, which may include physical therapy, occupational therapy, speech therapy, and cognitive rehabilitation.
  5. Patient may require follow-up appointments with their neurosurgeon or other specialists to monitor their progress and address any ongoing issues.
  6. Some patients may require a second unplanned brain surgery if complications arise, such as a delayed or enlarged hematoma, stroke, brain swelling, or other issues.
  7. Patients with specific risk factors, such as the presence of a contralateral craniocerebral injury feature (CCIF), may be at increased risk for needing a second surgery on the opposite side of the brain.
  8. Overall, the patient’s recovery and rehabilitation process can be lengthy and may require ongoing medical care and support.

What to Ask Your Doctor

  1. What are the potential complications of a craniotomy procedure?
  2. How long is the recovery time after a craniotomy?
  3. What are the risks associated with a second unplanned brain surgery after a craniotomy?
  4. How will you monitor for any signs of complications that may require a second surgery?
  5. Are there any specific factors or features in my case that may increase the likelihood of needing a second surgery?
  6. What are the signs and symptoms that I should watch out for after the initial craniotomy that may indicate the need for a second surgery?
  7. How will you determine if a second surgery is necessary, and what factors will you consider in making that decision?
  8. What are the potential long-term effects of needing a second surgery after a craniotomy?
  9. What is the success rate of a second surgery for complications after a craniotomy?
  10. Are there any preventive measures or strategies that can reduce the risk of needing a second surgery in the future?

Reference

Authors: Fu S, Hou P, Wang G, Wang S. Journal: BMC Surg. 2023 Apr 4;23(1):78. doi: 10.1186/s12893-023-01977-w. PMID: 37016346