Minimally invasive procedures (either diagnostic or therapeutic, neurosurgi-cal or multidisciplinary) play a major role in the management of patients with traumatic brain injury (TBI). Minimalism is the backbone of multimodality monitoring, which plays such an important role in preventing secondary cerebral insults and neurological decline (1-5). Such surgical techniques are also used in respiratory and nutritional management of patients with severe head injury who need long-term rehabilitation (6).

Multimodality monitoring measures used in neurotrauma intensive care units include SpO2, End-Tidal pCO2, intracranial pressure (ICP), cerebral perfusion pressure (CPP), SjVO2, PbrO2 and perhaps in the future microdialysis (7-11). Minimally invasive surgical techniques are used in percutaneous drainage of subdural hematomas, percutaneous tracheostomy, and gastroje-junostomies (6,12,13).

Prior to sectional imaging, treatment of TBI was primarily based on anecdotal expert opinion and not evidence based. Studies of Quickenstd (14) indicated increased intracranial pressure in TBI; however, Lundberg and Langfitt for the first time showed us how important it was to monitor intracranial pressure (14-16). In the 1970s, with the introduction of the Glasgow Coma Scale GCS and computed tomography (CT) scan, clinicians attempted a more aggressive approach in managing severe head injury (17). The importance of ICP in outcome was clearly defined by Miller et al. (18). Experimental and clinical studies indicated low cerebral blood flow very early after major head trauma, setting the stage for the introduction of monitoring CPP and the state of brain tissue oxygenation by jugular bulb oxygen saturation and brain tissue oxygenation (19-22). Whether microdialysis and continuous monitoring of cerebral blood flow (CBF) will become a part of our daily monitoring of brain metabolism remains to be seen (23).

From: Minimally Invasive Neurosurgery, edited by: M.R. Proctor and P.M. Black © Humana Press Inc., Totowa, NJ

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