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This issue of Neurosurgical Focus is devoted to headinjury. Although this is certainly a broad topic, an attemptwas made both to revisit old topics in a new light as wellas to include an investigation into new frontiers.

The first set of articles propose treatment paradigmspredicated on clinical data. Aarabi, et al., and Levy focuson penetrating craniocerebral injuries, deriving prognosticfactors for the outcomes of epilepsy and GlasgowOutcome Scale scores. Kim, et al., investigate the out-come of pediatric head injury suffered in falls.Interestingly, these authors found that poor outcomes dooccur after falls from low height, and they urge the clini-cian to have a low threshold of suspicion for intracranialpathological lesions in evaluating these patients. Larson,et al., provide a review of traumatic intracranialaneurysms associated with blunt injury. These lesions aremore common in children, although their true overall inci-dence remains unknown.

The second grouping of articles, by Farace and Alves aswell as Kraus, et al., examine gender differences in headinjury. Both studies found that women were more likely tosuffer a worse outcome from head injury. Although large-ly ignored in most prospective trials and entirely dis-counted in clinical trials, gender differences in outcomefrom head injury can provide insight into the pathophysi-ology of both injury and recovery from injury as well as

aid future clinical trials through randomization schemesdesigned to include gender. These articles also bring tomind the commonly seen biases in study design and thedifficulties inherent in comparing two patient cohorts thatmay be less similar than they seem.

The final set of articles examines the pathophysiologi-cal bases for head injury and presents various means of addressing these processes. It begins with a plea by Dr.Kamano for further investigation on the use of steroids forsevere head injury. While one of only three standards inthe Guidelines for the Management of Severe HeadInjury states that the use of glucocorticoids is not rec-ommended for improving outcome in patients with severehead injury, Dr. Kamano provides a well-constructedargument for the reexamination of this statement. One of the purposes of the guidelines effort is to stir additionalinvestigation; this review should result in debate on thistopic and, one hopes, further study. Moreno, et al., addressthe role of vascular dynamics in outcome following headinjury and find prognostic information in transcranialDoppler ultrasonography. Winkler, et al., find that changesin cerebral blood flow and glucose metabolism can becuriously effected by cranioplasty, resulting in improvedoutcomes. Last, methodical research by Reinert, et al.,shows that extracellular potassium concentration is at leastassociated with poor outcome.

Neurosurg Focus 8 (1): Intro , 2000

Head Injury

TORD D. A LDEN , M.D. AND M ARK D. K RIEGER , M.D.

Neurosurg. Focus / Volume 8 / January, 2000 1