Progress in head injury management.

Preventable secondary injury remains disturbingly common and can only be reduced by highly organized and integrated services, and careful and continuous monitoring. Continuous non- or relatively non-invasive bedside monitoring of factors closely related to brain metabolism and function is becoming a practical reality. To the extent that the complex changes initiated by traumatic brain injury are 'processes' rather than 'events' it may become possible for components of injury to be halted or reversed. Pharmacological therapy given early after injury may be able to reduce the harmful events initiated by the injury. Head injury management is multidisciplinary. Improvements in head injury outcome have come about through better organisation of services - efficient retrieval, early investigation and removal of clots, and management in experienced intensive care units. Australian neurosurgeons have played a leading role in defining standards of care, in organizing services and in raising public health issues related to head injury. With the increasing and necessary involvement of other specialists and the greater dependence on technically demanding intensive monitoring and medical management, it is important that neurosurgeons remain at the forefront of the care of patients with head injury and not simply be reduced to managing the surgical complications on request.(86).