Wells, A.J.Viaroli, E.Hutchinson, P.J.2025-07-162025-07-162021Surgery (Oxford), 2021; 39(8):470-4780263-93191878-1764https://hdl.handle.net/2440/146035Traumatic brain injury (TBI) is a huge global problem with an increasing socioeconomic impact. Current understanding of the pathophysiology of TBI has led to a systematic approach towards management in the pre-hospital, operating theatre and critical care settings, with early management directed towards protecting the brain from secondary injury. TBI is a spectrum of diseases, and rapid radiological identification of the underlying pathology is paramount to determine appropriate surgical intervention. Most modern neurocritical care centres augment intracranial pathophysiology with intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targeted therapies at a minimum. Decompressive craniectomy (DC) can be a useful mechanism to control medically refractory intracranial hypertension and reduce mortality; however, it also results in a spectrum of outcome categories and remains a controversial topic. There is emerging evidence that TBI is a chronic illness, with increased incidence of cognitive and behavioural deficits, neurodegenerative disease, and an increased mortality that extends well beyond the initial TBI stage. Ongoing research into novel biomarkers may yield future therapeutic targets to improve clinical outcomes.en© 2021 Published by Elsevier Ltd.Decompressive craniectomy; intracranial haematoma; intracranial pressure; management; neurocritical care; neuroradiology; operative management; traumatic brain injuryJournal article10.1016/j.mpsur.2021.06.0092024-06-12584461Wells, A.J. [0000-0002-4373-347X]