• Ko-Ting Chen, Shih-Tseng Lee, and Chieh-Tsai Wu.
• Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
• World Neurosurg. 2017 Feb 1; 98: 727-733.e3.

ObjectiveA subset of surgically treated patients with traumatic brain injury (TBI) cannot be stabilized by initial surgery. Mobile computed tomography (CT) provides real-time information for diagnosis in these TBI surgically high-risk (TBI-SHR) patients. The objective of this study was to analyze a 5-year series of TBI-SHR patients to evaluate the impact of intraoperative mobile CT (imCT) on prognosis.MethodsOf 1017 surgically treated patients with TBI retrospectively reviewed over a 5-year period (2009-2013), 59 patients required second operations within 72 hours of their initial surgery because of progressive or delayed hematomas (TBI-SHR group). Their clinical, radiographic, and intraoperative findings were compared among 19 patients who received imCT versus 40 patients who received fixed-unit CT.ResultsOur TBI-SHR group accounted for 5.8% of all surgically treated patients with TBI. The use of imCT led to a change in surgical plan in 56% of patients with TBI intraoperatively. Younger patients (≤55 years; P < 0.05) with multifocal hemorrhage on preoperative CT (P = 0.033) and with an intraoperative unexpected event such as intraoperative intracranial pressure >20 mm Hg or acute brain swelling after adequate decompression (P = 0.003 and 0.004, respectively) significantly benefited from imCT in the TBI-SHR group. imCT also provided a quicker diagnosis (P < 0.001), led to a trend toward shorter intensive care unit stays (P = 0.077), and was associated with better neurologic outcomes at discharge days (P = 0.044).ConclusionsThe use of imCT is associated with better neurologic outcomes at discharge days compared with the use of fixed-unit CT in TBI-SHR patients.Copyright © 2016 Elsevier Inc. All rights reserved.

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