Original ArticlesTraumatic Brain Injury: Current Management, Controversies, and Clinical TrialsYadla, Sanjay MD; Campbell, Peter G. MD; Jallo, Jack MD, PhDAuthor Information Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA The authors declare no conflict of interest. Reprints: Jack Jallo, MD, PhD, Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut 2nd Floor, Philadelphia, PA 19107 (e-mail: [email protected]). Neurosurgery Quarterly: August 2011 - Volume 21 - Issue 3 - p 168-179 doi: 10.1097/WNQ.0b013e3182126191 Buy Metrics Abstract Traumatic brain injury (TBI) continues to have a significant financial and social impact on society. The pathophysiology of TBI is commonly classified into 2 processes. Primary injury describes the structural injuries sustained from mechanical forces of the initial impact. Secondary injury describes the physiological processes that follow, including intracranial hypertension and ischemia. The former is addressed through public health awareness and prevention, whereas the latter is the focus of inhospital management and a significant body of research. In 2007, the Brain Trauma Foundation published its latest edition of guidelines on the management of patients with severe TBI based on the best available evidence. Parameters for the most common aspects of management are covered with accompanying recommendations (i.e, level I, II, or III) based on the strength of the underlying data. Still, several areas of controversy remain. Hypertonic solutions to manage intracranial pressure, brain tissue oxygen monitors, transfusion thresholds, and the role of decompressive hemicraniectomy for intractable intracranial pressures are topics of considerable debate. Clinical trials of a number of promising pharmacotherapies are ongoing as are 2 phase III randomized trials of decompressive craniectomy. Ongoing and future trials in TBI should be conducted using the best possible methodologies to avoid the clinical futility found in past trials of promising therapies. © 2011 Lippincott Williams & Wilkins, Inc.