Neurotrauma

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on the neurotrauma. Carotid-cavernous fistula (CCF) is an abnormal communication between the carotid artery and the venous plexus of the cavernous sinus. Computed tomography (CT) angiography should be obtained after trauma in patients with neurologic signs and symptoms that are not explained by the CT-scan or in blunt trauma patients presenting with epistaxis from a suspected arterial source. The gold standard for the diagnosis of blunt cerebrovascular injury is cerebral digital subtraction arteriography, and should be only performed if the suspicion remains high and the findings of other imaging are equivocal. Attention to the management of severe traumatic brain injuries is now focused on maintaining or enhancing cerebral perfusion rather than merely lowering intracranial pressure (ICP). The management of patients with CCF includes monitoring of ophthalmologic status, treatment of ophthalmologic complications, and closure of the CCF.