Neurotraumatology

Neurotraumatology deals with injuries of the head or spine that occur due to accidents. Injuries may affect neural (brain, spinal cord) as well as bony structures (skull, spine). Most of our patients are young people with traumatic brain injury (TBI) that were involved in traffic accidents. But we also treat an increasing number of elderly patients with head injuries due to bagatelle traumata. Traumatic brain injury (TBI) accounts for the majority of all our trauma patients. While approximately one third of all patients with a so-called severe TBI die, about 10% survive with severe disabilities.

As a university hospital located within the Alps with numerous opportunities for sports and leisure activities within our catchment area, we serve as the primary referral center for neurotrauma patients in western Austria.

All patients with a diagnosed or suspected neurotrauma will be admitted to the hospital via the trauma room, where a team of various specialists (anesthesiologists/intensivists, neurosurgeons, trauma surgeons, neurologists, pediatricians, ophthalmologists, etc.) will be already awaiting the patient. Initial measures will be taken to stabilize the patient and further assess their medical condition. This includes a trauma CT scan of the whole body and additional specified examinations depending on the injuries the patient has.

• If the patient requires immediate surgery, they will be directly transferred to the neurosurgical operating theatre. When the intervention is finished, the patient will be admitted to our intensive care unit, where specialized doctors and nurses take care of their further treatment and observation.
• If no surgical intervention is necessary initially, the patient will be admitted to the neurosurgical or neurological intensive care unit for further observation and imaging, depending on the type and severity of the injury and on capacities.

Neuromonitoring

Patients lying on our neurosurgical intensive care unit with a severe head injury are unconscious and artificially ventilated because of their head injury. That means, they are not easily accessible for assessments of their neurological condition. Neuromonitoring is a way of gaining information about the brain’s condition by measuring certain parameters continuously while the patients is sedated. These measurements are done via different kinds of very thin probes that are placed inside the brain:

• Measurement of intracranial pressure: Patient with a severe head injury often develop increased intracranial pressure, which is known to worsen the patient’s chances of a good outcome after TBI. A thin probe is used for continuous measurement of the pressure inside the skull. This helps us to adapt our treatment decisions and to assess how the patient is doing.
• Measurement of brain tissue oxygenation: This probe gives us additional information about the oxygen supply of the brain which is important for the prevention of secondary complications like stroke

Transcranial Doppler Sonography

The transcranial Doppler (TCD) sonography is a non-invasive examination that is being performed routinely by the neurosurgeons of our department. The TCD is an ultrasound examination of the head, where the blood vessels inside the head can be easily assessed. It gives us information about the blood supply of the brain and helps to detect vessel contractions (“vasospasm”) that may cause stroke.