Understanding the Kinds of Surgery for Head Injury

Posted on April 29, 2022

Besides damage to the brain itself, some head injuries can lead to serious problems that have life-threatening effects. Some of these complications can be treated with medications. But some will require immediate surgery.

Conditions requiring surgery after head injury include:

  1. Hydrocephalus: occurs when cerebrospinal fluid (CSF) accumulates in the ventricles (cavities in the brain that produce CSF), putting pressure on the brain and further damage.
  2. Skull fractures. These usually accompany penetrating brain injuries and can tear the protective covering on the brain. The tears can also allow bacteria and air into the brain, causing serious infections.
  3. Intracerebral hemorrhages. Hemorrhages occur when an artery in the brain bursts, causing bleeding in the brain tissue. This is a life-threatening emergency that requires swift treatment to limit the damage.
  4. Hematomas are pools of blood outside blood vessels. Hematomas can occur within the brain tissue itself, in the space between the skull and the brain's outer layer, and between the outer layer and the brain tissue.

Types of Surgery for Head Injury Complications

Surgery can treat the conditions listed above but must be done within a few hours to prevent damage permanently.

Here are some types of surgery to treat head injuries:

1. Craniotomy with Open Surgery
In Craniotomy, if a hematoma is large enough, the neurosurgeon will remove a section of the skull to drain the hematoma. A craniotomy allows the brain, if it is swollen, to bulge out of the skull and reduce intracranial pressure, which is critical for inhibiting more injury. Once the hematoma is drained, doctors can directly operate on the brain to repair the broken blood vessels to stop further bleeding and swelling.

In addition, hematomas smaller than one centimeter can be treated with less invasive surgery with an aspiration procedure. A surgeon will drill a small burr hole into the skull, will place rubber tubes into the holes, and allow the hematoma blood to drain out.

2. Endoscopic Ventriculostomy
This type of surgery is mainly used to treat hydrocephalus, which causes an excess of cerebral spinal fluid in the brain. The surgeon inserts a small video camera into your skull to see directly inside your brain, then creates a hole in the bottom of one of the ventricles allowing CS fluid to drain out of the brain.

3. Ventriculoperitoneal Shunt Surgery (VPS)
VPS surgery is used for hydrocephalus treatment that involves the surgical insertion of a drainage system, also known as a shunt which is a long, flexible tube with a valve at one end to drain fluid from the brain at a continuous rate.

For the shunt to work correctly, one end is positioned in one of the brain's ventricles, while the other end is channeled under the skin to another body part, usually the abdomen. The spinal fluid drains into the abdominal cavity, where the body absorbs it

4. Decompressive Craniectomy
If intracranial pressure (ICP) remains elevated and does not respond to medication, doctors will need to perform an emergency decompressive craniectomy. Surgeons use craniectomies to remove open skull fractures also, which prevents the fracture from penetrating the brain tissue.

However, since these surgeries are risky, doctors prefer to use them as a last resort and will resort to these procedures instead: 

  • Medication to decrease swelling
  • Oxygen therapy
  • Therapeutic hypothermia

5. Cranioplasty
Finally, patients usually have to undergo reconstructive surgery of their skull, also known as cranioplasty, after recovering from craniectomy.

The skull vault is repaired during a cranioplasty by inserting plastic or metal plates. If the damage is not too severe, the person's skull bone can be reinserted. Cranioplasty helps the person avoid recurrent brain damage, protects them from seizures, and relieves trephine syndrome, which sometimes occurs after removing a large skull bone.

Cranioplasty can also help increase cerebral blood flow and improve brain metabolism.

After the surgery, you will require rapid rehabilitation to heal correctly. The sooner you begin therapy, the better chance you will make a full recovery. The most frequently practiced therapies are: 

  • Speech therapy
  • Occupational therapy
  • Physical therapy