Gkantsinikoudis Nikolaos, Hossain Iftakher, Marklund Niklas, Tsitsopoulos Parmenion P
Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece.
Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland.
Brain Spine. 2024 Aug 13;4:102907. doi: 10.1016/j.bas.2024.102907. eCollection 2024.
A subgroup of severe Traumatic Brain Injury (TBI) patients, known as ultra-severe (us-TBI), is most commonly defined as a post-resuscitation Glasgow Coma Scale (GCS) of 3-5. There is uncertainty on whether these critically injured patients can benefit from neurosurgical intervention.
The available evidence regarding the decision-making and outcome following management of us-TBI patients is critically reviewed.
Selected databases (PubMed, Google Scholar, Scopus and Cochrane Library) were searched from 1979 to May 2024 for publications on us-TBI patients, with a focus on treatment strategy, mortality and functional outcomes. Inclusion criteria were adult patients >18 years old with closed head trauma and admission post-resuscitation GCS 3-5. Studies were independently assessed for inclusion by two reviewers, and potential disagreements were solved by consensus.
Where such data could be extracted, mortality rate was 27-100%, and favorable outcome was observed in 4-30% of us-TBI patients. While early aggressive neurosurgical management was associated with decreased mortality, a high proportion of patients survived with unfavorable functional status.
With supportive care only, outcome of patients with us-TBI is almost universally poor. Early and aggressive neurosurgical intervention in addition to best medical management can lead to favorable functional outcome in selected cases particularly in younger patients with an initial GCS>3 and traumatic mass lesions. There is insufficient data regarding the effectiveness of neurosurgical management on the outcome of us-TBI patients. and the decision to initiate treatment should be based on an individual basis.
重度创伤性脑损伤（TBI）患者中有一组被称为超重度（us-TBI），最常见的定义是复苏后格拉斯哥昏迷量表（GCS）评分为3 - 5分。这些重伤患者是否能从神经外科干预中获益尚不确定。
对关于us-TBI患者管理后的决策和结果的现有证据进行严格审查。
检索1979年至2024年5月选定的数据库（PubMed、谷歌学术、Scopus和Cochrane图书馆），以获取关于us-TBI患者的出版物，重点关注治疗策略、死亡率和功能结局。纳入标准为年龄大于18岁的闭合性颅脑外伤成年患者，且复苏后入院时GCS评分为3 - 5分。由两名评审员独立评估研究是否纳入，潜在分歧通过协商解决。
在能够提取此类数据的情况下，死亡率为27% - 100%，4% - 30%的us-TBI患者观察到良好结局。虽然早期积极的神经外科治疗与死亡率降低相关，但很大一部分患者存活下来时功能状态不佳。
仅采用支持性治疗时，us-TBI患者的结局几乎普遍较差。除了最佳的药物治疗外，早期积极的神经外科干预在某些特定情况下，特别是初始GCS>3且有创伤性肿块病变的年轻患者中，可导致良好的功能结局。关于神经外科治疗对us-TBI患者结局有效性的数据不足，治疗决策应基于个体情况。
