Because the normal pressure inside the skull may increase after an injury due to swelling of the brain, one important step taken in the first stages of treatment is to measure that pressure. This pressure is known as intracranial pressure, or ICP. Because the increase in ICP can be dangerous, it needs to be closely watched using an ICP monitor. Dr. Freeman, can you tell us how elevated ICP is treated?
Sure thing, Dr. Hemstad. If the ICP rises too high, medications are given to reduce the pressure, slow brain function down, and increase blood flow to the injured part of the brain. The patient can also be placed on a breathing machine, known as a ventilator. If the ICP monitor shows that the intracranial pressure is building to a dangerous level, a catheter may be used to drain cerebral spinal fluid from the brain.
In some cases of moderate to severe TBI, surgery may be required to reduce the intracranial pressure and provide space for any swelling of the brain. There are two kinds of surgery that are often used to do this. One of these involves the temporary removal of part of the skull, in the form of a bone flap. This procedure is called a craniotomy. The brain can then be accessed for treatment, pressure on the brain is relieved, and the bone flap is replaced.
If the bone is not replaced immediately, the procedure is called a craniectomy. In this case, the original bone may be replaced at a later time, or an artificial replacement, made specifically for the patient, may be used. While the bone flap is not in place, many patients wear a helmet to protect their brain.