Versorgung von Kopfverletzungen

Zusammenfassung

Schädelhirntraumata (SHT) sind weltweit von großer sozioökonimischer Bedeutung. Sie sind die häufigste Ursache für eine langfristige Behinderung, Erwerbsunfähigkeit und Mortalität bei jungen Erwachsenen. Für eine erfolgreiche Behandlung des SHT-Patienten ist die interdisziplinäre Betreuung durch ein spezialisiertes Team von Neuro-, MKG- und Unfallchirurgen, Neuroanästhesisten, Neurointensivmedizinern, Neuroradiologen sowie HNO-Ärzten erforderlich. Pathophysiologisch werden beim SHT primäre und sekundäre Hirnschäden unterschieden. Da sekundäre Schäden potenziell vermeid- oder zumindest limitierbar sind, sind sie das Ziel neuroprotektiver Maßnahmen im intensivstationären Setting und ein Hauptgegenstand der klinischen Forschung. Dem Hirndruckmanagement kommt hierbei eine besondere Bedeutung zu. Unterschiedliche intrakranielle Blutungstypen werden anhand ihrer Ätiologie, ihres Ausbreitungsmusters und des zugrundeliegenden Pathomechanismus differenziert. Die Versorgung von SHT richtet sich nach der Schwere und dem Ausmaß des Traumas und reicht von einer ambulanten/stationären Überwachung bis zur notfallmäßigen Entlastungskraniotomie. Multicenter-Beobachtungsstudien, wie Center-TBI (Europa) oder TRACK-TBI (USA), helfen dabei, Behandlungsalgorithmen stetig zu verbessern und weiterzuentwickeln. Dabei sollten neueste Studienergebnisse eine schnelle Implementierung in internationalen Guidelines finden („living systematic reviews“). Präventiven Maßnahmen fällt zudem eine besondere Bedeutung zu, da sie ein Sicherheitsbewusstsein schaffen und somit behilflich sind, etwaigen schweren Kopfverletzungen vorzubeugen.

Abstract

Traumatic brain injuries (TBIs) are of major socioeconomic importance worldwide and are the most common cause of long-term disability, incapacity and mortality in young adults.
Successful treatment of the TBI patient requires interdisciplinary care by a specialised team of neurosurgeons, maxillofacial surgeons, trauma surgeons, neuroanaesthetists, neurointensivists, neuroradiologists and ENT physicians.
A distinction is made pathophysiologically between primary and secondary brain damage in TBI. Since secondary damage is potentially preventable or at least limitable, the principle objectives of neuroprotective measures in the intensive care setting and in clinical research are to limit secondary damage. Intracranial pressure management is of particular importance in this context.
Different types of intracranial haemorrhage are differentiated according to their aetiology, their pattern of spread and the underlying pathomechanism. The management of TBIs depends on the severity and extent of the trauma and ranges from outpatient/inpatient monitoring to emergency relieving craniotomy.
Multicentre observational studies, such as Center-TBI (Europe) or TRACK-TBI (USA), help to continuously improve and develop treatment algorithms. The latest study results should be rapidly implemented in international guidelines ("living systematic reviews"). Preventive measures are also of particular importance, as they create safety awareness and thus help to prevent possible serious head injuries.

Schlüsselwörter

SHT - Hirndruckmanagement - Hirnblutung - Entlastungskraniotomie - ICP-Messung - Kopfverletzung

Key words

SHT - intracranial pressure management - intracranial pressure - decompressive craniectomy - ICP measurement - head injury

Publication History

Article published online:
15 November 2021

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