David W Van Wyck, Gerald A Grant and Daniel T Laskowitz
Penetrating traumatic brain injury (pTBI) remains one of the most devastating and lethal forms of trauma. Prognosis is generally poor and, for those who survive long enough to make it to the hospital, the management of penetrating brain injury presents complex challenges to medical and surgical providers in the civilian sector. Recent experiences in Operation Iraqi Freedom and Operation Enduring Freedom have provided opportunities to study and refine the surgical and medical management of pTBIs that may impact civilian evaluation and management of similar traumas. These experiences demonstrated that aggressive pre-hospital and emergency department resuscitation, followed by immediate surgical management and post-operative intensive care to monitor for and intervene on surgical and medical complications could significantly improve patient outcomes. We begin with a brief case vignette that will introduce a comprehensive discussion on the epidemiology, pathophysiology, evolution of current surgical and medical therapies, complications, and prognostic indicators that may improve outcomes in these challenging cases.