Neurosurgical Critical Care

The overarching goal of neurosurgical critical care is to prevent potential deleterious effects of secondary brain injury. The initial management of patients with traumatic brain injury prioritizes the assessment of injury severity and prevention of hypotension and hypoxemia. The assessment of severity in patients with traumatic brain injury is important for determining the need for intubation and need for placement of intracranial monitoring. The stepwise management of increased intracranial pressure following traumatic brain injury is emphasized to prevent cerebral herniation syndromes and cerebral infarcts. Treatment with glucocorticoids following acute spinal cord injury is not recommended. Operative indications for intracranial monitor placement, hemicraniectomy, and spinal decompression are reviewed.   This review contains 1 figure, 3 tables and 32 references Key Words: glucocorticoids in spinal cord injury, hemicraniectomy, intracranial hypertension, multimodal monitoring, secondary brain injury, spinal cord injury, spinal decompression, traumatic brain injury