Advancements in neurosurgical techniques for managing sports-related traumatic brain injuries

Background: Sports-related Traumatic Brain Injury (TBI) is a public health concern, often requiringneurosurgical intervention. Outcomes vary widely across sports, yet remain underreported. Methods: We conducted a PRISMA-guided systematic review and meta-analysis of sports-related TBI in athletes, focusing on injury mechanisms, neurosurgical interventions, and clinical outcomes, including return-to-play. PubMed, Embase, and MEDLINE were searched; studies reporting injury mechanisms, neuroimaging or hemorrhage types, neurosurgical procedures, and outcomes were included. Two reviewers independently screened and extracted data, and proportions were pooled using random-effects models. Results: A total of 42,112 patients were included (62.0 ​% male; mean age 20.1 years). Skiing/snowboarding, football, and cycling were the leading sports associated with TBI. Across all sports, the mean GCS was 13.5, and average return to practice occurred at 5.4 months. Helmet use was confirmed in only 17 ​% of patients and 8.8 ​% of cyclists. Among cyclists, 27 ​% had ICH at presentation, with subdural hematoma being the most common type (32.1 ​%). Mechanisms of injury varied by sport, with falls dominating in cycling, horse riding, skiing, and skateboarding. Meta-analysis showed concussions were the most common injury (pooled proportion 0.11), followed by contusions (0.05). Hemorrhages included SDH (0.17), EDH (0.05), and SAH (0.04). Skull fractures occurred in 18 ​% of cases. Neurosurgical intervention was required in 21 ​% of patients, most commonly craniotomy (7 ​%). Mortality was low (<3 ​%), and favorable outcomes were frequent (93 ​%). Return to play was high overall (96 ​%) but only 23 ​% within 1 month. Helmet use was low overall (17 ​%) and varied substantially across different sports and study settings. Conclusions: Outcomes and surgical needs vary by sport. Targeted prevention and individualized carestrategies are essential.