The future role of neurosurgery in the care of head injuries.

Head injuries are major cause of death and disability under the age of 45 years even in developing countries. Mortality and morbidity are frequently due to avoidable secondary brain damage in patients whose initial injury was not very severe. Optimal care depends on neurosurgeons defining clear management policies for injuries of all severities so that other surgeons know which patients need neurosurgical care and know how to deal with the others. More patients need to go to neurosurgeons; only specialized centers dealing with many cases can develop advanced clinical skills and have the capability to carry out major clinical research. In the competitive world of high technology medicine neurosurgery needs to deliver good care for head injuries in the community as a whole if it is to attract substantial support.