Neurocritical Care

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on the neurocritical care. A number of studies have consistently demonstrated no role for steroids in the management of acute traumatic brain injury. Steroids are still occasionally used to treat headaches that accompany concussion syndrome, but this is usually in the later stages of the injury and presumably reduces the mild vasogenic edema. The vasogenic edema associated with brain tumors are also treated with steroids on occasion with good symptomatic relief. As with most medical devices used in the intensive care unit, ventriculostomy removal should occur as soon as possible when the perceived risk of complications outweighs the benefits of their use. Ventriculostomy catheters are used extensively for both elective and traumatic brain injury neurosurgical patients, but there are very little controlled randomized data to definitively answer the question of true infection risk.