Controversies in Severe Traumatic Brain Injury Management

1. Front Matter

   Pages i-xii

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2. Prehospital Transportation and Optimal Utilization of Resources

   • Sanjay Konakondla, Shelly D. Timmons

   Pages 1-7

3. To Treat or Not to Treat: Early Withdrawal of Therapy and the Limits of Prognostic Ability

   • Young Lee, Angel Ordaz, Michael Huang, Geoffrey T. Manley

   Pages 9-16

4. Use of Multimodality Neuromonitoring in the Management of Traumatic Brain Injury

   • Justin R. Davanzo, Emily P. Sieg, J. Christopher Zacko, Shelly D. Timmons

   Pages 17-28

5. Choice of Intracranial Pressure Monitoring Modality: Parenchymal Monitor vs. Parenchymal Monitor with Brain Tissue Oxygen Monitor vs. External Ventricular Drain

   • Christian B. Ricks, David O. Okonkwo

   Pages 29-36

6. Oxygen Management and Prevention of Cerebral Ischemia

   • Ashley Ralston, M. Ross Bullock

   Pages 37-46

7. What Is the Optimal Sedative Regimen in Severe Traumatic Brain Injury Patients?

   • Bradley A. Boucher

   Pages 47-60

8. Fluid and Electrolyte Management: Hyperosmolar Euvolemia and the Use of Hypertonic Saline for Intracranial Hypertension

   • Hussain Shallwani, Justice O. Agyei, John F. Morrison, Kevin J. Gibbons

   Pages 61-74

9. Pituitary and Other Hormonal Derangements in Severe Traumatic Brain Injury

   • Courtney Pendleton, Jack Jallo

   Pages 75-82

10. Management to Optimal Parameters: Euboxia?

    • Kyle Mueller, Anthony Conte, Rocky Felbaum, Randy Bell, Shelly D. Timmons, Rocco Armonda

    Pages 83-98

11. Nutrition: Time to Revisit?

    • Rani Patal, Guy Rosenthal

    Pages 99-105

12. Deep Vein Thrombosis and Venous Thromboembolism Prophylaxis in Traumatic Brain Injury: Current Treatment Options and Controversies

    • Timothy J. Kovanda, Richard B. Rodgers

    Pages 107-116

13. Treatment of Anemia

    • Peter Le Roux

    Pages 117-143

14. Timing of Extracerebral Operations in Severe Traumatic Brain Injury Patients

    • P. B. Raksin

    Pages 145-163

15. Optimal Treatment of Dysautonomia

    • Gabriel N. Friedman, Ziev B. Moses, Ian Tafel, William B. Gormley

    Pages 165-177

16. Use of Consciousness-Enhancing Medications in the Traumatic Brain Injury Patient

    • Justin R. Davanzo, Shelly D. Timmons

    Pages 179-190

17. Management of Traumatic Brain Injury in the Face of Antithrombotic Medication Therapy

    • Jonathan H. DeAntonio, Kimberly N. Means, Sudha Jayaraman, Gretchen M. Brophy

    Pages 191-205

18. Use of Guidelines in the Management of Traumatic Brain Injury

    • Ilyas Eli, Evan Joyce, Gregory W. J. Hawryluk

    Pages 207-230

19. Functional Neurosurgery for Sequelae of Traumatic Brain Injury

    • William R. Y. Carlton Jr., Gregory J. A. Murad

    Pages 231-246

20. The Future of Clinical Trials in Traumatic Brain Injury

    • David S. Hersh, Beth M. Ansel, Howard M. Eisenberg

    Pages 247-256

This text addresses the current levels of evidence for management of a variety of critical parameters after severe traumatic brain injury (TBI), as well as providing the reader with practical approaches to care based upon existing evidence.  A broad range of topics is included, ranging from specific critical care approaches to TBI to broader questions of prognostication and philosophies of treatment. Critical care topics include, for example: the type, timing, and safety of DVT prophylaxis; the choice of sedative agents in brain-injured patients; the practical application of multimodality neuromonitoring for prevention of secondary insults and injury; and the optimal treatment of dysautonomia. Broad approaches to treatment will include concepts such as: organization of trauma systems to maximize outcomes; end-of-life decision-making with incomplete data on prognosis; the use of medications to enhance recovery in the post-acute phase, and utilizing brain-machine interfaces for the restoration of function after injury. Written by experts in the field, each chapter is organized by proposal of a commonly encountered clinical question, addressing the current evidence for a variety of treatments, outlining the relevant questions on the topic that have not been adequately addressed in the literature, summarizing the options for treatment and the level of evidence upon which each is based, and finally proposing questions yet to be addressed in the literature. The text identifies in each chapter the ongoing questions for future research relevant to the topic at hand as well as providing a comprehensive educational reference for resident and fellowship training. 

• Polytrauma
• Multimodality Neuromonitoring
• ICP Monitoring Modality
• Mechanoprophylaxis
• Chemoprophylaxis
• Dysautonomia
• Trauma Surgery

“The book provides an excellent resource that addresses many important and controversial questions in sTBI, and I recommend that it should be read by trainees and practitioners in neurosurgery, intensive care, trauma care, emergency medicine, and anesthesia. … this book should be made accessible to every emergency department, intensive care ward, and neurosurgical ward in hospitals that treat patients with sTBI.” (Gavin A. Davis, Neurosurgery, Vol. 85 (1), July, 2019)

“This is a valuable book that will undoubtedly help those who manage patients with severe TBI navigate this complex landscape. There is no comparable book examining controversies in management of severe TBI, making this one quite unique. The authors present relevant controversies and do a nice job of applying current scientific data in a clearly understood manner.” (Fady T. Charbel, Doody's Book Reviews, January, 18, 2019)​

• Department of Neurosurgery, Penn State University Milton S. Hershey Medical Center, Hershey, USA

  Shelly D. Timmons

Shelly D. Timmons, MD, PhD, FACS, FAANS
Professor of Neurosurgery
Vice Chair for Administration
Director of Neurotrauma
Penn State University Milton S. Hershey Medical Center
30 Hope Drive
Hershey, PA  17033

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