[Diagnosis and surgical treatment of craniocerebral trauma within the scope of polytrauma management].

Head trauma of different degrees is present in about two-thirds of multiple trauma patients admitted to hospital. As the primary brain damage is irreversible, our objective should be the recognition and specific treatment of both early and late complications. Stabilization of cardiorespiratory parameters must first be achieved. Secondly, only the diagnosis and treatment of life-threatening hemorrhages is of greater importance than the diagnostic and therapeutic measures undertaken by the neurosurgeon. Coma is assessed according to the Glasgow Coma Scale. The indications for CT investigation in trauma patients are: (1) loss of consciousness for more than 30 min (GCS score under 8); (2) manifest neurological deficit; (3) open head injury; (4) deterioration of clinical and neurological status after admission; (5) skull fracture. An algorithm for the management of head trauma, including the above-listed criteria and based on Schweiberer's "Graduated Schedule for Diagnosis and Treatment of Multiple Trauma" is presented. We also list the indications for urgent early neurosurgical intervention: (1) space-occupying intracranial hemorrhages, epi- or subdural, and intracerebral; (2) open head injury; (3) space-occupying impression fractures; (4) any combination of the above. In some cases neurosurgery may be performed after further stabilization, e.g., in: (1) fronto- and otobasal injuries (the latter often heal spontaneously); (2) small contusions; (3) not-space-occupying extracerebral hematomas with no tendency to increase; (4) not-space-occupying impression fractures. As soon as neurological deficit appears in the presence of one of the above, operative treatment is mandatory.