Surgical tactics for the management of patients with multiple brain injuries in the presence of a risk of delayed brain damage in the acute period of TBL

Multiple parenchymal brain injuries (foci of contusion and/or intracerebral hematomas) are characterized by a very rapid development of diffuse edema and dislocation of the brain as a result of the combined effects of all foci, leading to early disorders of cerebral circulation and cerebrospinal fluid circulation, which leads to high mortality in this cohort of patients. The present study is devoted to the search for optimal indications for timely surgical intervention in this group of patients. A retrospective study of 54 patients with delayed parenchymal hemorrhagic brain injuries in the acute period of traumatic brain injury was conducted. Patients were treated at the State Medical Institution «Clinical Hospital of Emergency Medicine» in Tver from 2016 to 2022. All patients had severe isolated or combined traumatic brain injury (ICD diagnosis code: S06.3, T06.8), which led to a fatal outcome. Based on the results of statistical studies, a surgically significant total volume of the lesion and/or intracerebral hematoma was determined, amounting to 30 cm3 in patients with multiple parenchymal brain injuries.