Journal of surgery and research最新文献

{"title":"Timely Surgical Approaches for Pediatric Epilepsy Resistant to Medication.","authors":"Tyler Williams, Spencer Collins, Edgar Sanchez, Devendra K Agrawal","doi":"10.26502/jsr.10020513","DOIUrl":"10.26502/jsr.10020513","url":null,"abstract":"<p><p>Meckel's Pediatric drug-resistant epilepsy (DRE) is a significant neurological disorder that develops when seizures persist despite treatment with two appropriately selected antiseizure medications. Although only a subset of children with epilepsy develops DRE, prolonged uncontrolled seizures during childhood can result in irreversible cognitive, behavioral, and developmental impairment. Over time, growing evidence has demonstrated that epilepsy surgery is an effective treatment for appropriately selected patients and that earlier surgical intervention is associated with improved relief from seizures and long-term neurodevelopmental outcomes. This review examines the mechanisms underlying pharmaco-resistance, including network reorganization, neuroinflammation, blood-brain barrier dysfunction, and structural abnormalities that contribute to epileptogenesis. Common surgically remediable causes of pediatric DRE, including focal cortical dysplasia, mesial temporal sclerosis, tuberous sclerosis complex, hemimegaloencephaly, and tumor-associated epilepsy, are discussed along with current surgical approaches, including resective, disconnective, and minimally invasive procedures. The evidence comparing early versus delayed surgical intervention is reviewed with emphasis on seizure control, cognitive development, language, behavior, and quality of life. Finally, this review highlights persistent barriers to timely surgical referral, including socioeconomic, geographic, and racial disparities, while exploring emerging advances in neuroimaging, artificial intelligence-assisted lesion detection, and imaging biomarkers that may improve early diagnosis and patient selection. Collectively, the available evidence supports earlier referral for surgical evaluation in children with DRE and suggests that prompt intervention may preserve neurodevelopment, improve long-term functional outcomes, and maximize quality of life.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"9 3","pages":"244-255"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic and Robotic Appendectomy: Efficiency and Cost Comparison.","authors":"Madeleine T Dang, Shaanali Mukadam, Chang Kon Kim, Daniel H Choi, Timothy J Chu, Devendra K Agrawal","doi":"10.26502/jsr.10020519","DOIUrl":"https://doi.org/10.26502/jsr.10020519","url":null,"abstract":"<p><p>Acute appendicitis is a common cause of emergency abdominal surgery, most frequently affecting adolescents and young adults. Diagnosis is often complicated by variable clinical presentations, and timely recognition is critical to prevent complications such as perforation, peritonitis, and intra-abdominal abscess formation. Minimally invasive surgery (MIS) has transformed the operative management of appendicitis with laparoscopic appendectomy (LA) established as the standard operative approach due to reduced surgical trauma, faster recovery, lower complications rates, and shorter hospital stay compared to open appendectomy. Robotic appendectomy (RA) has emerged as a newer MIS alternative, offering enhanced visualization, instrument articulation, and ergonomic advantages that may address some technical limitations of conventional laparoscopy. The objective of this review is to examine and summarize current evidence comparing LA and RA in the management of acute appendicitis, including operative time, conversions rates, postoperative recovery, complications, cost, and training considerations. While LA consistently demonstrates favorable outcomes and cost-effectiveness across diverse patient populations, RA may provide incremental benefits in selected cases, particularly those with complex anatomy or increased technical difficulty. However, RA is associated with substantially higher operative and total costs, greater resource utilization, and the need for specialized equipment and trained personnel. By evaluating operative outcomes, patient recovery, and healthcare resource utilization, this review highlights the strengths, limitations, and clinical applicability of both minimally invasive approaches. Current evidence suggests that LA will likely remain the dominant approach for the foreseeable future due to its broad applicability, proven efficacy, and cost effectiveness, whereas RA may continue to grow in niche or complex cases where its technical advantages can be fully leveraged.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"9 3","pages":"285-296"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Cholecystectomy: Outcomes, Safety, and Value in the Era of Advanced Technology.","authors":"Shaanali Mukadam, Madeleine T Dang, Chang Kon Kim, Timothy J Chu, Daniel H Choi, Devendra K Agrawal","doi":"10.26502/jsr.10020518","DOIUrl":"https://doi.org/10.26502/jsr.10020518","url":null,"abstract":"<p><p>Robotic cholecystectomy has been increasingly adopted across general surgery, driven by potential advantages in visualization, instrument articulation, ergonomics, and fluorescence-guided biliary identification. However, its clinical value relative to conventional laparoscopic cholecystectomy remains debated, particularly given higher procedural costs and mixed comparative safety data. This narrative review synthesizes contemporary evidence from 2020 to 2025 comparing robotic and laparoscopic cholecystectomy, with emphasis on operative outcomes, perioperative recovery, complex biliary disease, cost, and patient-reported outcomes. Current data suggest that robotic cholecystectomy is associated with modestly longer operative time during early adoption, although efficiency may improve with increasing procedural familiarity and standardized workflow. Conversion to open surgery is a recurrent favorable outcome reported with robotics, particularly in difficult gallbladders, obesity, acute inflammation, and reoperative or post-inflammatory settings. Intraoperative safety findings remain heterogeneous. Population-level analyses have raised concern regarding bile duct injury, whereas contemporary institutional, registry, and nonelective analyses report low or comparable bile duct injury rates. Postoperative recovery, length of stay, wound complications, readmission, quality of life, and patient satisfaction are generally similar between approaches, with limited evidence of modest early pain or recovery advantages in selected studies. Economic data are more consistent, showing higher direct and indirect costs for robotic cholecystectomy and unfavorable cost-effectiveness in routine elective disease. Overall, contemporary evidence does not support routine replacement of laparoscopic cholecystectomy with robotic cholecystectomy for uncomplicated gallbladder disease. The robotic platform may be best positioned for selective use in technically complex cases where enhanced visualization, articulation, and operative control could reduce conversion risk or facilitate minimally invasive completion. Future prospective, severity-adjusted studies incorporating surgeon experience, patient-centered recovery, and full cost accounting are needed to clarify where robotic cholecystectomy provides measurable clinical value.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"9 3","pages":"273-284"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-Stratified Use of Topical and Infiltrative Local Anesthetics in High-Risk Dermatologic Surgery.","authors":"Seyedshayan Shojaei, Kimia Heidari, Alhasan Alobaidi, Devendra K Agrawal","doi":"10.26502/jsr.10020489","DOIUrl":"10.26502/jsr.10020489","url":null,"abstract":"<p><p>Local anesthetics are fundamental to dermatologic practice, yet their safety profile requires nuanced understanding in high-risk contexts including end-arterial sites, barrier-compromised skin, and scenarios predisposing to systemic toxicity. This narrative review synthesizes contemporary evidence across these three interacting domains to provide an integrated, risk-stratified framework for clinical decision-making. Regarding end-arterial territories, over two decades of clinical evidence encompassing more than 200,000 digital and acral injections has effectively dismantled the historical dogma against epinephrine use in digits, nose, ear, and penis, demonstrating an excellent safety profile when dilute concentrations are used in patients with adequate perfusion, with phentolamine providing reliable rescue for rare, prolonged vasoconstriction. In barrier-compromised skin (e.g. burns, ulcers, and inflammatory dermatoses) topical anesthetics function as absorption amplifiers, with dramatically accelerated systemic uptake that can precipitate local anesthetic systemic toxicity or prilocaine- and benzocaine-induced methemoglobinemia, particularly in infants and frail elderly patients. For large, denuded areas, dilute tumescent infiltration offers a pharmacokinetically safer alternative to high-dose topical therapy. The review details systemic toxicity risk factors, recognition, and management, emphasizing that intravenous lipid emulsion therapy has transformed severe toxicity from an often-fatal event to a manageable emergency. Special considerations for pediatric and geriatric populations, drug interactions, and cumulative dosing across modalities are addressed. The overarching conclusion is that context-sensitive risk stratification which includes integrating vascular status, barrier integrity, and host pharmacokinetics combined with office preparedness including phentolamine and lipid emulsion, enables safe local anesthesia even in traditionally high-risk dermatologic scenarios.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"9 1","pages":"54-75"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12970946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147438207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Anxiety and Stress Cortisol on Postoperative Pain: Pharmacological and Non-Pharmacological Management Strategies.","authors":"Aren Yarcan, Alexander Abdou, Devendra K Agrawal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Postoperative pain remains a significant clinical challenge associated with delayed recovery, prolonged rehabilitation, and increased healthcare utilization. Despite advances in analgesic techniques, outcomes remain variable, suggesting that non-physical factors such as perioperative stress and anxiety play an important role. A relationship between perioperative anxiety, stress, and postoperative pain was examined with emphasis on physiologic mechanisms, assessment strategies, and management approaches. A narrative review was conducted using PubMed searches of the studies published in last 25 years. Search terms included cortisol, stress, perioperative surgery, postoperative pain, sex differences, questionnaires, and therapeutic interventions. Peer-reviewed studies involving human subjects were included if they evaluated perioperative stress, cortisol dynamics, postoperative pain, or related interventions. Preoperative anxiety is consistently associated with increased postoperative pain and higher analgesic requirements. Activation of the Hypothalamic-Pituitary-Adrenal Axis and subsequent cortisol release represents a key mechanism linking stress to pain modulation; however, significant variability limits the role of cortisol as a standalone biomarker. Validated tools such as the Brief Measure of Emotional Preoperative Stress, State-Trait Anxiety Inventory, and Hospital Anxiety and Depression Scale can identify high-risk patients but remain underutilized. Sex differences are evident, with women reporting higher pain scores and stronger associations between anxiety and postoperative pain. Non-pharmacological interventions, including music therapy and perioperative communication, demonstrate modest benefit, while pharmacological strategies show variable efficacy. Perioperative stress and anxiety significantly influence postoperative pain outcomes. A multimodal, patient-centered approach incorporating structured assessment and targeted interventions may improve recovery and optimize perioperative care.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"9 2","pages":"165-175"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Effects of Brain Death and Circulatory Death on Myocardial Integrity and Transplant Outcomes.","authors":"Chang Kon Kim, Shaanali Mukadam, Devendra K Agrawal","doi":"10.26502/jsr.10020466","DOIUrl":"10.26502/jsr.10020466","url":null,"abstract":"<p><p>Heart transplantation is the definitive treatment for end-stage heart failure, yet the persistent scarcity of donor organs has necessitated expanded criteria for donor selection, particularly the inclusion of donors after brain death (DBD) and circulatory death (DCD). These two mechanisms of donor death result in distinct pathophysiological alterations that impact myocardial viability, inflammatory activation, and immune recognition. DBD is characterized by a catecholamine surge, hormonal collapse, and systemic inflammation, contributing to endothelial dysfunction and immunologic priming. In contrast, DCD grafts are subjected to warm ischemia and reperfusion injury, elevating the risk of primary graft dysfunction and delayed recovery. These physiological differences may differentially influence graft performance, immunologic rejection, infection risk, and long-term survival. This review presents a detailed analysis of how the cause of donor death influences clinical outcomes in heart transplantation. It explores the mechanistic underpinnings of DBD- and DCD-associated injury, assesses their impact on post-transplant complications, and evaluates emerging strategies such as ex vivo perfusion, donor-derived cell-free DNA monitoring, and gene expression profiling. Additionally, it discusses how donor physiology intersects with recipient characteristics, the selective use of heterotopic transplantation, and evolving approaches in immunosuppression and risk stratification. These insights support the development of precision-guided protocols that integrate donor and recipient profiles to optimize graft utilization and improve outcomes.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"8 3","pages":"416-435"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A \"Watchful Surgery\" Approach: Timing and Valve Choice for Mildly Symptomatic Mitral and Aortic Valve Disease.","authors":"Shaanali Mukadam, Chang Kon Kim, Devendra K Agrawal","doi":"10.26502/jsr.10020472","DOIUrl":"10.26502/jsr.10020472","url":null,"abstract":"<p><p>The timing of surgical intervention and prosthesis selection in mildly symptomatic aortic and mitral valve disease remain an area of clinical uncertainty. Symptom-based referral often occurs after the onset of adverse ventricular remodeling, whereas earlier surgery may improve long-term outcomes but introduces procedural risk. This article synthesized contemporary evidence to delineate optimal strategies in this intermediate-risk population. In aortic stenosis, randomized trials including RECOVERY and AVATAR demonstrate that early surgical aortic valve replacement reduces heart failure events and may improve survival. In aortic and mitral regurgitation, observational data associate early intervention, triggered by mild symptoms or subclinical ventricular dysfunction, with improved survival and preservation of cardiac function. Emerging modalities such as global longitudinal strain and natriuretic peptide biomarkers enhance risk stratification in asymptomatic individuals. Prosthesis selection is primarily informed by patient age, comorbidity burden, and anticoagulation tolerance. Mechanical valves confer superior durability and lower reoperation risk in younger patients. Bioprosthetic valves are increasingly favored in older adults due to compatibility with transcatheter valve-in-valve reintervention and avoidance of lifelong anticoagulation. Comparative cohort studies and meta-analyses suggest a survival benefit for mechanical valves up to approximately 65-to-70 years of age, beyond which the benefit diminishes due to competing mortality risks. Evidence supports timely surgical referral in mildly symptomatic patients, particularly in the presence of early imaging or biomarker evidence of ventricular dysfunction. Individualized decision-making through multidisciplinary heart team evaluation remains essential. Further investigations are warranted to define long-term prosthetic durability and the role of early surgery in valvular regurgitation.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"8 3","pages":"460-476"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting bleeding risk in PAD patients on antiplatelets using TEG coagulation testing.","authors":"Adriana A Rodriguez Alvarez, Isabella Ferlini Cieri, Mounika Boya, Shiv Patel, Anahita Dua","doi":"10.26502/jsr.10020456","DOIUrl":"10.26502/jsr.10020456","url":null,"abstract":"<p><strong>Introduction: </strong>Bleeding is a major concern while using antithrombotic therapy. While Thromboelastography with Platelet Mapping (TEG-PM) predicts postoperative bleeding and platelet dysfunction in trauma, its utility in peripheral artery disease (PAD) remains unclear. Hence, this study aimed to evaluate whether platelet inhibition (PI) and maximum amplitude of adenosine diphosphate (MA ADP) can predict bleeding risk in PAD.</p><p><strong>Methods: </strong>Patients with PAD undergoing lower extremity revascularization between 2021-2025 were prospectively evaluated and monitored for one year to identify bleeding events. Bleeding events were defined as clinically significant hemorrhages that required medical intervention or transfusion. Patients were stratified based on the occurrence of bleeding, and descriptive statistics characterized each group. The Mann-Whitney U test assessed differences in platelet function, while receiver operating characteristic (ROC) analysis determined the optimal TEG-PM cutoff values for predicting increased bleeding risk.</p><p><strong>Results: </strong>A total of 234 patients were analyzed, of whom 14 (5%) experienced a bleeding event. The bleeding cohort exhibited higher platelet inhibition (94.5% vs. 24.1%; p<0.0001) and lower MA ADP (22.4 vs. 52; p<0.0001), suggesting reduced platelet aggregation and clot strength. ROC analysis revealed platelet inhibition >86.4% (AUC: 0.89, sensitivity: 71%, specificity: 92%) and MA ADP <31.9 (AUC: 0.85, sensitivity: 79%, specificity: 85%) as predictive thresholds for bleeding risk.</p><p><strong>Conclusion: </strong>High platelet inhibition (>86.4%) and low MA ADP (<31.9%) may serve as indicators of bleeding risk in PAD patients on antiplatelets, highlighting the potential utility of TEG-PM in guiding personalized antithrombotic management.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"8 3","pages":"335-341"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12360087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing pressure injuries in individuals with impaired mobility: Best practices and future directions.","authors":"Amber Peterson, Marcel P Fraix, Devendra K Agrawal","doi":"10.26502/jsr.10020455","DOIUrl":"10.26502/jsr.10020455","url":null,"abstract":"<p><p>Pressure injuries, also known as decubitus ulcers or bedsores, are a major source of preventable morbidity among individuals with impaired mobility, particularly those recovering from spinal cord injury, stroke, or traumatic brain injury. These wounds not only prolong hospital stays and increase healthcare costs but also significantly impair rehabilitation outcomes and quality of life. This paper provides a comprehensive review of the pathophysiology and risk factors underlying pressure injury development, emphasizing the unique vulnerabilities of patients with sensory loss, malnutrition, obesity, and incontinence. It synthesizes current best practices in prevention, including repositioning schedules, the use of pressure-redistributing support surfaces, moisture control, and nutritional optimization. The role of risk assessment tools such as the Braden Scale is examined alongside newer technologies like pressure mapping systems, Artificial intelligence-based prediction algorithms and biofeedback tools enhance individualization of care. Pharmacologic strategies and wound management principles, including debridement and antimicrobial use, are discussed in the context of multidisciplinary rehabilitation. Implementation challenges such as staffing constraints, variability across care settings, and financial limitations are addressed, and future directions are proposed to better integrate skin integrity metrics into functional outcome measures. Ultimately, this review advocates for a proactive, interdisciplinary approach that aligns preventive strategies with personalized care and emerging technology, positioning pressure injury prevention as a core component of high-quality, value-based medicine.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"8 3","pages":"319-334"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Most Effective Interventions for Enhancing Neural Plasticity for Functional Recovery in Patients with Traumatic Brain Injury.","authors":"Ambria Pogue, Devendra K Agrawal","doi":"10.26502/jsr.10020479","DOIUrl":"10.26502/jsr.10020479","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a major global health concern and one of the leading causes of disability worldwide. Outcomes of this injury range from full recovery to lifelong cognitive, physical, and psychological impairments. Management of TBI remains challenging due to the variety of symptoms and severity, as well as the complexity of the underlying cellular mechanisms. In addition, the lack of standardized treatment protocols contributes to the uncertainty of recovery. This article explores current evidence of the most effective interventions in improving function in patients with TBI. Acute management focuses on patient stabilization, tight control of intracranial pressure, and seizure prophylaxis. Long-term recovery, however, is dependent on a multidisciplinary approach including compensatory cognitive training with supported employment and social communication therapy, which have been shown to accelerate return to work and social reintegration. In addition, structured exercise, dietary modifications, and environmental enrichment have proven to be helpful. Novel therapeutic therapies including neuromodulation techniques and regenerative medicine strategies show promise in enhancing neuroplasticity and repairing injured neural tissue. Although encouraging, these treatments remain experimental, and no FDA approved disease modifying agents exist currently. Future progress will likely center around advancing these novel interventions as well as developing reliable biomarkers to help assess injury severity, predict prognosis, and guide individualized treatment planning.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"8 4","pages":"518-525"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13160283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}