The Role of Neurosurgery in Global Health Head Trauma

Twenty-seven million people are estimated to sustain a traumatic brain injury (TBI) every year. In this chapter, we first begin by considering the history of the diagnosis and treatment of TBI from trepanation in the Mesolithic period to seminal advances in the twentieth century such as CT scanning, ICP monitoring and the creation of the Glasgow Coma Score. Thereafter, we consider contemporary efforts to reduce morbidity and mortality due to TBI. Firstly, we review efforts to prevent TBI including helmet usage. We then consider the issues globally in the provision of adequate pre-hospital care, critical care, surgery and rehabilitation for this patient cohort. Throughout the chapter, we highlight specific issues faced in low-resource settings such as a lack of functional CT scanners and trained neurosurgeons. Moreover, we discuss innovative ways to provide high-quality care despite these challenges such as task sharing and the novel utilisation of existing technologies. Finally, we consider exciting new methodologies to improve care for these patients including precision medicine and systems science.