{"id":7418,"date":"2026-06-20T03:05:56","date_gmt":"2026-06-20T03:05:56","guid":{"rendered":"https:\/\/gothi.gov.eg\/?page_id=7418"},"modified":"2026-06-20T03:11:38","modified_gmt":"2026-06-20T03:11:38","slug":"%d8%ac%d8%b1%d8%a7%d8%ad%d8%a9-%d9%85%d8%ae-%d9%88%d8%a3%d8%b9%d8%b5%d8%a7%d8%a8","status":"publish","type":"page","link":"https:\/\/gothi.gov.eg\/?page_id=7418","title":{"rendered":"\u062c\u0631\u0627\u062d\u0629 \u0645\u062e \u0648\u0623\u0639\u0635\u0627\u0628"},"content":{"rendered":"\t\t
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\u062c\u0631\u0627\u062d\u0629 \u0645\u062e \u0648\u0623\u0639\u0635\u0627\u0628\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n Traumatic Brain edema <\/span>\n\n <\/h5>\n\n
\n
“last update: 13 March \u00a02025”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/span>Download Guideline<\/u><\/strong><\/a><\/h5><\/div><\/div><\/div>
\u00a0<\/div><\/div><\/div><\/div>

– Executive Summary<\/h3>

This topic is concerned with diagnosis and treatment guidelines of traumatic brain edema.<\/p>

\u27a1\ufe0fRecommendations:<\/u><\/i><\/b><\/p>

Conservative Management of traumatic brain edema is divided into 4 tiers:<\/u><\/i><\/b><\/p>

Tier 0<\/u><\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0Head elevation.<\/p>

o\u00a0\u00a0\u00a0Strong recommendation<\/p>

\u25aa\ufe0fAvoid hypoxia.<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0Avoid hypotension<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0Secure the airway (endotracheal intubation) in patients with GCS \u22648 who are unable to maintain their airway or who remain hypoxic despite supplemental O2 with ICP monitoring.<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0Brain imaging (CT) must be available and repeated as much as needed. (if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0We recommend ICU admission and close neurological observation with \u00a0CT monitoring for the development and progression of brain stem compression. ( if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

Tier 1<\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0We recommend mannitol for control of IC-HTN (within hospitals).<\/p>

\u25aa\ufe0f\u00a0\u00a0Intermittent boluses may be more effective than continuous infusion<\/p>

\u25aa\ufe0f\u00a0\u00a0Effective doses range from 0.25\u20131 gm\/kg body weight<\/p>

\u25aa\ufe0f\u00a0\u00a0Avoid hypotension (SBP < 90mm Hg) which may result from the diuretic effect of mannitol, which can lead to decreased circulating fluid volume<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0Try to adjust partial pressure of carbon dioxide (PaCO2) at lower ranges of normal val\u00adues (i.e. 35-38 mmHg).<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation.<\/p>

Tier 2<\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0Consider the use of neuromus\u00adcular blocking agents (NMBAs).<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0We recommend targeting a cerebral perfusion pressure (CPP) of 60-70mm Hg<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0Try to adjust the partial pressure of CO2 at 32-35 mmHg (mild hypocapnia)<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

Tier 3<\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0High-dose barbiturate therapy may be used for IC-HTN refractory to maximal medical and surgical ICP-lowering therapy. Patients should be hemodynamically stable before and during treatment.<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0The availability of equipped neurosurgery operating room is essential for management. (if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u27a1\ufe0f\u00a0\u00a0Surgical Intervention<\/b>:<\/u><\/p>

\u25aa\ufe0f\u00a0\u00a0We recommend decompressive craniectomy \u00b1 duroplasty for patients with late refractory ICP elevations<\/p>

o\u00a0\u00a0\u00a0Strong recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0Timing of surgery: patients meeting surgical criteria should be operated as soon as possible due to the potential for rapid deterioration<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/i><\/p>

\u00a0<\/p><\/div><\/div>

\u00a0<\/div><\/div>
\u00a0<\/div><\/div><\/div><\/div><\/div> <\/div>\n\n <\/div>\n
\n\n
\n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n Traumatic Brain contusions <\/span>\n\n <\/h5>\n\n
\n
“last update: 13 March \u00a02025”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span>Download Guideline<\/u><\/strong><\/a><\/h5><\/div><\/div><\/div>
\u00a0<\/div><\/div><\/div><\/div>

– Executive Summary<\/h3>

This topic is concerned with management guidelines of traumatic cerebral contusions<\/p>

Recommendations:<\/u><\/i><\/b><\/p>

Initial Management:<\/i><\/b><\/p>

\u25aa\ufe0f\u00a0Avoid hypoxia.<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Avoid hypotension.<\/p>

o\u00a0\u00a0\u00a0Strong recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0Secure the airway (endotracheal intubation) in patients with GCS \u22648 who are unable to maintain their airway or who remain hypoxic despite supplemental O2. (if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Brain imaging (CT) must be available and repeated as much as needed. (if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0We recommend ICU admission and close neurological observation with CT monitoring for the development and progression of brain stem compression. ( if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0Follow-up head CT scan within 6 to 8 hours following brain injury must be obtained.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ( if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0The availability of equipped neurosurgery operating room is essential for management. \u00a0\u00a0\u00a0(if not available refer to a tertiary center)<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u27a1\ufe0fConservative management:<\/u><\/b><\/p>

\u25aa\ufe0f\u00a0We recommend seizures prophylaxis in patients with frontal and temporal lobe cerebral contusions<\/p>

o\u00a0\u00a0\u00a0Strong recommendation<\/p>

\u27a1\ufe0fMechanisms to reduce ICP is divided into 3 tiers:<\/u><\/b><\/p>

If elevation of ICP is confirmed clinically and\/or radiologically or ICP\u00a0 monitoring (if available) the priority is control of ICP:<\/b><\/p>

Tier 0<\/b><\/p>

Head elevation and the same measures in the initial management<\/p>

o\u00a0\u00a0\u00a0Strong recommendation<\/p>

Tier 1<\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0\u00a0\u00a0We recommend mannitol for control of IC-HTN (within hospitals).<\/p>

\u25aa\ufe0f\u00a0\u00a0Intermittent boluses may be more effective than continuous infusion<\/p>

\u25aa\ufe0f\u00a0\u00a0Effective doses range from 0.25\u20131 gm\/kg body weight<\/p>

\u25aa\ufe0f\u00a0\u00a0Avoid hypotension (SBP < 90mm Hg) which may result from the diuretic effect of mannitol, which can lead to decrease circulating fluid volume<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0\u00a0Try to adjust partial pressure of carbon dioxide (PaCO2) at lower ranges of normal val\u00adues (i.e. 35-38 mmHg).<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation.<\/p>

Tier 2<\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0\u00a0Consider the use of neuromus\u00adcular blocking agents (NMBAs).<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0\u00a0We recommend targeting a cerebral perfusion pressure (CPP) of \u00a060-70mm Hg<\/p>

o\u00a0\u00a0\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Try to adjust the partial pressure of CO2 at 32-35 mmHg (mild hypocapnia)<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

Tier 3<\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0High-dose barbiturate therapy may be used for IC-HTN refractory to maximal medical and surgical ICP-lowering therapy. Patients should be hemodynamically stable before and during treatment.<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u27a1\ufe0fSurgical intervention<\/u><\/b>:<\/u>\u00a0surgery may be indicated in the following indications:<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0\u00a0Progressive neurological deterioration referable to the TICH, medically refractory IC-HTN<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Signs of mass effect on CT<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0TICH volume > 50cm3 cc or ml<\/p>

\u25aa\ufe0f\u00a0\u00a0GCS = 6\u20138 with frontal or temporal TICH volume > 20 cm3 with midline shift\u00a0 \u2265 5mm\u00a0 and\/or compressed basal cisterns on CT<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u27a1\ufe0fTypes of surgery:<\/u><\/b><\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0If the contusion with the surrounding edema cause mass effect according to the site you may do frontopolar lobectomy or tempropolar lobectomy<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0If the hemorrhagic contusion coalesced to form intracerebral hematoma you may do evacuation<\/p>

o\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Decompressive craniotomy with duroplasty may be indicated in cases in which the usual mechanisms to reduce the ICP are uneffective.<\/p>

o\u00a0\u00a0\u00a0\u00a0Conditional recommendation<\/p>

\u00a0<\/p><\/div><\/div>

\u00a0<\/div><\/div>
\u00a0<\/div><\/div><\/div><\/div><\/div> <\/div>\n\n <\/div>\n
\n\n
\n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n Depressed Skull Fractures <\/span>\n\n <\/h5>\n\n
\n
“last update: 13 March \u00a02025”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Download Guideline<\/strong><\/u><\/a><\/h5><\/div><\/div><\/div>
\u00a0<\/div><\/div><\/div><\/div>

– Executive Summary<\/h3>

This topic is concerned with management guidelines of depressed skull fractures.<\/p>

\u27a1\ufe0fRecommendations<\/i><\/strong><\/p>

<\/a>Initial Management: (as a part of initial TBI management)<\/u><\/strong><\/p>

\u25aa\ufe0f\u00a0Avoid hypoxia.<\/p>

\u00b2\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0Secure the airway (endotracheal intubation) in patients with GCS \u22648 who are unable to maintain their airway or who remain hypoxic despite supplemental O2.<\/p>

\u00b2\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0Avoid hypotension.<\/p>

\u00b2\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0We recommend ICU admission and close neurosurgical observation with CT monitoring if needed (if not available, refer to a tertiary center).\u00a0<\/p>

\u00b2\u00a0Strong recommendation.\u00a0<\/p>

\u25aa\ufe0f\u00a0The availability of equipped neurosurgery operating room is essential for management (if not available, refer to a tertiary center).\u00a0<\/p>

\u00b2\u00a0Strong recommendation.<\/p>

\u25aa\ufe0f\u00a0Anti-seizure medications (ASM):<\/p>

Consider the use of ASMs (e.g., phenytoin, valproate, or carbamazepine) to decrease the incidence of early PTS (within 7 days of TBI).<\/p>

\u00b2\u00a0Conditional recommendation<\/p>

\u27a1\ufe0fDefinitive management<\/strong><\/p>

\u25aa\ufe0f\u00a0\u00a0surgical management may be indicated in Patients with open (compound) depressed cranial fractures (evidenced by CT) with:<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Depression greater than the thickness of the cranium.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Clinical (CSF leak \/ hernia cerebri) or radiographic (pneumocephalus) evidence of dural violation.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Underlying significant intracranial hematoma or hemorrhagic contusions.<\/p>

\u25aa\ufe0f\u00a0Frontal sinus involvement.<\/p>

\u25aa\ufe0f\u00a0\u00a0Gross cosmetic deformity.<\/p>

\u25aa\ufe0f\u00a0\u00a0\u00a0Wound infection.<\/p>

\u25aa\ufe0f\u00a0\u00a0Dural venous sinuses compromise impeding blood flow as evident in 3D CT and MRV brain.<\/p>

\u00b2\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0Surgery may be indicated for closed depressed skull fractures if:<\/strong><\/u><\/p>

–\u00a0\u00a0the depression is causing a focal deficit through pressure on the adjacent cortex.<\/p>

–\u00a0\u00a0the closed fracture is depressed and causing a cosmetic abnormality, for example fractures over the forehead.<\/p>

\u00b2\u00a0Conditional recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0Surgery (if indicated) is recommended as soon as possible after stabilization and coverage of umbrella of antibiotics.<\/p>

\u00b2\u00a0\u00a0Strong recommendation<\/p>

\u25aa\ufe0f\u00a0\u00a0patients with open (compound) depressed cranial fractures may be treated conservatively in the absence of the previously mentioned surgical indications.<\/p>

\u00b2\u00a0Conditional recommendation<\/p>

\u00a0<\/p><\/div><\/div>

\u00a0<\/div><\/div>
\u00a0<\/div><\/div><\/div><\/div><\/div> <\/div>\n\n <\/div>\n <\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

\u062c\u0631\u0627\u062d\u0629 \u0645\u062e \u0648\u0623\u0639\u0635\u0627\u0628 Traumatic Brain edema “last update: 13 March \u00a02025”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-7418","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7418","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7418"}],"version-history":[{"count":7,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7418\/revisions"}],"predecessor-version":[{"id":7429,"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=\/wp\/v2\/pages\/7418\/revisions\/7429"}],"wp:attachment":[{"href":"https:\/\/gothi.gov.eg\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7418"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}