Surgery of Cerebral Trauma

first type of neurosurgical procedure performed by ancient peoples several millennia ago. Even as recently as last century, as neurosurgery was rapidly growing as a specialty and as new practitioners began to settle in more and more cities across the United States, trauma patients continued to be a major part of the clinical volume of many of these newly established practices. The last three decades have been alternately exhilarating and frustrating for those with clinical and research interests in traumatic brain injury (TBI). Laboratory and bedside research has greatly improved our understanding of posttraumatic cerebral pathophysiology (Fig. 1). At the same time, these new insights have failed to make the transition to clinically useful therapies. Many of the major clinical trials of the last decades have been “negative” studies that have shown us what does not work. It has been extraordinarily difficult to demonstrate the efficacy of new treatments. Identifying new treatments and proving their utility have been seemingly insurmountable obstacles. Progress has been made, however, in other arenas. Careful reevaluation of existing data and publications can help in identifying which pracSURGERY OF CEREBRAL TRAUMA AND ASSOCIATED CRITICAL CARE