TRAUMATIC BRAIN INJURY: NEUROSURGICAL DECISION-MAKING AND INTRACRANIAL PRESSURE MONITORING IN CRITICAL CARE
DOI:
https://doi.org/10.36557/2674-9432.2026v5n1p2378-2388Palavras-chave:
traumatic brain injury; intracranial pressure monitoring; decompressive craniectomy; neurocritical care.Resumo
Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide and requires complex decision-making in critical care. This narrative review analyzes current updates in neurosurgical management and intracranial pressure (ICP) monitoring in moderate and severe TBI. A literature review was conducted using PubMed, Scopus, Web of Science, and SciELO databases (2015–2026), focusing on clinical trials, observational studies, guidelines, and relevant reviews addressing neurosurgical interventions and neurocritical monitoring strategies. Contemporary TBI management prioritizes prevention of secondary brain injury through physiology-guided treatment. Continuous ICP monitoring plays a central role in guiding stepwise therapeutic interventions, including sedation optimization, ventilation control, osmotherapy, and hemodynamic adjustments aimed at maintaining cerebral perfusion pressure. Decompressive craniectomy remains an important option for refractory intracranial hypertension, demonstrating mortality reduction in selected patients, although functional outcomes remain heterogeneous and dependent on baseline prognosis and timing of intervention. The incorporation of multimodal neuromonitoring, including brain tissue oxygenation, microdialysis, and autoregulation assessment, has shifted neurocritical care from a reactive to a preventive approach, enabling earlier detection of cerebral hypoperfusion and metabolic distress. However, challenges persist regarding interpretation of monitoring data, definition of surgical timing, and availability of specialized resources. Overall, optimal management of TBI depends on integration of clinical evaluation, imaging findings, and physiological monitoring, supported by structured protocols and trained multidisciplinary teams.
Downloads
Referências
ABDOLLAHIFARD, S. et al. Timing of intracranial pressure monitoring in traumatic brain injury: a systematic review and meta-analysis. Clinical Neurology and Neurosurgery, 2025. Available at: https://www.sciencedirect.com. Accessed on: Feb 10, 2026.
AIOLFI, A. et al. Brain Trauma Foundation guidelines for intracranial pressure monitoring: compliance and effect on outcome. World Journal of Surgery, v. 41, n. 6, p. 1543-1549, 2017. Available at: https://doi.org/10.1007/s00268-017-3898-6. Accessed on: Feb 10, 2026.
AROMATARIS, E.; MUNN, Z. (Eds.). JBI Manual for Evidence Synthesis. Adelaide: Joanna Briggs Institute, 2020. Available at: https://synthesismanual.jbi.global. Accessed on: Jan 10, 2026.
BÖGLI, S. Y. et al. Unlocking the potential of high-resolution multimodality neuromonitoring for traumatic brain injury management: lessons and insights. Critical Care, v. 29, 2025. Available at: https://doi.org/10.1186/s13054-025-05360-4. Accessed on: Feb 11, 2026.
CARNEY, N. et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery, v. 80, n. 1, p. 6-15, 2017. Available at: https://doi.org/10.1227/NEU.0000000000001432. Accessed on: Feb 12, 2026.
CNOSSEN, M. C. et al. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: a survey in 66 neurotrauma centers participating in the CENTER-TBI study. Critical Care, v. 21, p. 233, 2017. Available at: https://doi.org/10.1186/s13054-017-1816-9. Accessed on: Feb 11, 2026.
COOPER, D. J. et al. Patient outcomes at twelve months after early decompressive craniectomy for traumatic brain injury. Journal of Neurotrauma, 2020. Available at: https://www.liebertpub.com. Accessed on: Feb 12, 2026.
DENCHEV, K. et al. Traumatic brain injury: intraoperative management and intensive care unit multimodality monitoring. Anesthesiology Clinics, v. 41, n. 1, p. 39-78, 2023. Available at: https://doi.org/10.1016/j.anclin.2022.11.003. Accessed on: Feb 13, 2026.
FERRARI, R. Writing narrative style literature reviews. Medical Writing, v. 24, n. 4, p. 230-235, 2015.
HUTCHINSON, P. J. et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. New England Journal of Medicine, v. 375, n. 12, p. 1119-1130, 2016. Available at: https://doi.org/10.1056/NEJMoa1605215. Accessed on: Feb 10, 2026.
HUTCHINSON, P. J. et al. Consensus statement from the International Consensus Meeting on the role of decompressive craniectomy in the management of traumatic brain injury. Acta Neurochirurgica, v. 161, p. 1261-1274, 2019.
HUTCHINSON, P. J. et al. Decompressive craniectomy for traumatic intracranial hypertension: long-term outcomes of the RESCUEicp trial. The Lancet Neurology, v. 18, n. 7, p. 634-642, 2019. Available at: https://doi.org/10.1016/S1474-4422(19)30195-3. Accessed on: Feb 12, 2026.
MAGNUSSEN, A. S. et al. Multimodal neuromonitoring in the Nordic countries: implementation and outcomes. Acta Neurochirurgica Supplement, 2025. Available at: https://vbn.aau.dk. Accessed on: Feb 12, 2026.
MAAS, A. I. R. et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology, v. 16, n. 12, p. 987-1048, 2017.
O’DONNELL, J. C. et al. Multimodal neuromonitoring and neurocritical care in brain trauma research. Biomedicines, v. 11, n. 5, p. 1336, 2023. Available at: https://doi.org/10.3390/biomedicines11051336. Accessed on: Feb 12, 2026.
SUN, X. et al. Evaluation of intracranial pressure in patients with severe brain injury: quantitative CEUS and other methods. Neurocritical Care, 2026. Available at: https://doi.org/10.1007/s12028-026-02447-w. Accessed on: Feb 11, 2026.
TACCONE, F. S. Multimodal neuromonitoring in traumatic brain injury patients: the search for the holy grail. Annals of Intensive Care, 2023. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577936. Accessed on: Feb 10, 2026.
THAMILMARAN, A. Optimal timing of cranioplasty post-decompressive craniectomy and long-term outcomes. Journal of Neurosurgery/Neurotrauma Supplements, 2026. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789150. Accessed on: Feb 12, 2026.
ZOERLE, T. Intracranial pressure monitoring in adult patients with severe traumatic brain injury: indications and controversies. Neuroscience Reviews, 2024. Available at: https://www.sciencedirect.com. Accessed on: Feb 12, 2026.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2026 Bruna Gonçalves Manzoni, Rodolfo de Oliveira Medeiros, Lucileia Mazuqueli Marques, Dianah Dantas Pulvirenti, Fabiana Campos Castro Carvalho, Mirella Cristina Mazuqueli Marques, Ana Carolina Fontana Bolsoni, José Gabriel Cavalcanti Garcia, Maria Júlia Daniel Peixoto, Edna Pereira da Silva, João Pedro Zanatto, Arthur Menegucci Vicenconi
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Você tem o direito de:
- Compartilhar — copiar e redistribuir o material em qualquer suporte ou formato para qualquer fim, mesmo que comercial.
- Adaptar — remixar, transformar, e criar a partir do material para qualquer fim, mesmo que comercial.
- O licenciante não pode revogar estes direitos desde que você respeite os termos da licença.
De acordo com os termos seguintes:
- Atribuição — Você deve dar o crédito apropriado , prover um link para a licença e indicar se mudanças foram feitas . Você deve fazê-lo em qualquer circunstância razoável, mas de nenhuma maneira que sugira que o licenciante apoia você ou o seu uso.
- Sem restrições adicionais — Você não pode aplicar termos jurídicos ou medidas de caráter tecnológico que restrinjam legalmente outros de fazerem algo que a licença permita.
