SEVERE HEAD AND BRAIN INJURY

In medical services where acute accident patients are encountered, gen eral and traumatic surgeons are faced with the problem of treating sev ere head and brain injuries. In the Department of Surgery at the Unive rsity Hospital in Munich, we have been performing neurotraumatological treatment since 1983. We had 162 patients with seven head and brain i njuries, 95 intracerebral contusional bleeding, 8 depression fractures , and 3 hygromas. All these patients underwent surgical treatment. Ost eoplastic trepanation was performed in 68 patients and osteoclastic tr epanation in 65. Further interventions were elevation of the 8 depress ion fractures and evacuation of the 3 hygromas. Comparison with other investigations in departments of neurosurgical surgery in the United S tates suggest that our results reflect a similar outcome (according to Jennet and Bond's outcome scale: 1 cured; 2 slightly; 3 severely hand icapped; 4 vegetative state; 5 expired). The Traumatic Coma Data Bank (1991) recorded the outcome of severe head and brain injuries as follo ws: 1, 27%; 2, 16%; 3, 16%; 4, 5%; 5, 36%; and our own results were: 1 , 25%; 2, 16%; 3, 15%, 4, 5%; 5, 39%. Organization procedures and trea tment strategies are suggested.