HEADS OR TAILS
Authors: Papagheorghe Atena , Teleanu D. 
Published: November 2024

Introduction
Craniocerebral trauma oftentimes requires urgent neurosurgical interventions and poses a great threat on its own as a result of inherent complications. Surgery is performed in order to tackle immediate mortality and to enhance long-term recovery. However, it is noteworthy to take into consideration that we can distinguish complications that stem from the procedure itself from those which are attributable to the traumatic event and its physiopathology.

Objectives
This study is a comprehensive review of literature addressing complications related to surgery in traumatic brain injury. To further illustrate the findings, we studied the incidence of post-surgical complications in 100 patients from our department that underwent surgical procedures for head trauma.

Material and Methods
The databases that were enquired were PubMed and Scopus. Literature written in the past two decades has been analysed, with an emphasis on more recent meta-analyses. A retrospective cohort of 100 patients was assembled from our departments’ database. Inclusion criteria consisted of traumatic brain injury that required surgery. The main post-surgical complications (mentioned in the results) were identified and the rate of incidence was calculated using Microsoft Excel 2019.

Results
The complications related to surgical procedures for traumatic brain injury included the following medical entities: brain herniation, hydrocephalus, pneumocephalus, subdural hygroma, subdural effusion after decompression, cerebrospinal fluid leaks, infections, wound complications, syndrome of the trephined, cranioplasty-related issues and neuropsychological outcomes. Out of 100 surgeries for head trauma, we identified 13 cases in which complications occurred, as follows: 5 (35,7%) infections, 4 (28,6%) contralateral subdural effusion, 2 (14,3%) pneumocephalus, equal incidence of 1 (7,1%) for hygroma, intracerebral hematoma and contralateral epidural effusion. Additionally, this study explored comparisons of surgical techniques employed in head trauma (craniectomy vs craniotomy, types of incisions) and long term outcomes of patients.

Conclusions
This literature review highlights the most frequently encountered complications of head trauma surgery, as well as some exceptional ones, with the purpose of informing on previous and current management of such situations which a neurosurgeon may encounter, with special attention to young neurosurgeons, who can benefit from open space discussions on this topic with more experienced neurosurgeons.

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