Brain Trauma Surgery in Singapore

Traumatic brain injury can be a serious medical condition that affects patients and their families. In certain situations, brain trauma surgery may be required to address injury to the brain and manage complications such as bleeding, swelling, or pressure within the skull.

Patients have access to comprehensive neurosurgical care utilising recognised surgical techniques and medical technology. This overview aims to explain the role of brain trauma surgery, outline the treatment process, and provide general information on recovery and follow-up care, so patients and caregivers know what to expect during the course of treatment.

Dr Teo Kejia (张哿佳医生)

Senior Consultant Neurosurgeon

MBBS (SG)MRCS (Edin)FAMS (Neuro Surg)FRCS Ed (Neuro Surg)IFAANS

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Overview Candidates Treatment Process Recovery Benefits Risks Cost FAQS Conclusion

What is Brain Trauma Surgery?

Brain trauma surgery encompasses a range of neurosurgical procedures to manage injuries to the brain, blood vessels, and surrounding structures following a traumatic impact. These procedures may involve the removal of blood clots (haematomas), repair of skull fractures, relief of pressure within the skull, and management of complications that may arise after the initial injury.

Surgeons may perform emergency procedures within hours of injury or conduct planned operations days to weeks later, depending on the injury type and severity. Neurosurgical techniques can help neurosurgeons access injured brain areas through various approaches, ranging from traditional open surgery (craniotomy) to procedures using a thin tube with a camera (endoscopy).

These surgeries address conditions including:

Epidural haematomas: bleeding that occurs between the skull and the outer protective covering of the brain
Subdural haematomas: bleeding beneath the brain’s tough outer membrane (dura mater)
Intracerebral haemorrhages: bleeding directly within the brain tissue
Depressed skull fractures: broken skull bones that press inward on brain tissue

Who May Be Considered for Brain Trauma Surgery

Brain trauma surgery may be considered for patients meeting certain medical criteria, including:

Acute subdural or epidural haematomas (blood clots between the brain and skull) causing significant mass effect
Depressed skull fractures exceeding the thickness of the skull
Increased intracranial pressure (pressure inside the skull) that does not respond to medical mmanagement
Penetrating brain injuries requiring debridement (removal of damaged tissue) and repair
Individuals with brain contusions (bruising of the brain tissue), causing progressive neurological deterioration
Cerebrospinal fluid leaks (when the protective fluid surrounding the brain and spinal cord escapes) that may require surgical repair

Contradictions

Certain conditions may limit or delay surgical intervention, including:

Severe coagulopathy (blood clotting disorders that prevent normal clotting) requires correction first
Medically unstable patients who cannot tolerate anaesthesia
Extensive brain injuries with minimal likelihood of meaningful recovery
Multiple severe injuries that require prioritisation of life-threatening conditions
Advanced directives or family decisions against surgical intervention

Decisions regarding brain trauma surgery are made following careful assessment by a neurosurgeon. The specialist considers the patient’s overall condition, injury severity, and individual circumstances to determine whether surgery is appropriate.

Treatment Techniques & Approaches

Craniotomy for Haematoma Evacuation

This open surgical approach involves creating a bone flap, which is a section of skull bone that is temporarily removed, to access and remove blood collections. The neurosurgeon carefully removes the haematoma while managing bleeding, preserving the surrounding brain tissue. This technique provides direct visualisation for complex injuries.

Decompressive Craniectomy

For significant brain swelling, a portion of the skull may be temporarily removed to relieve pressure. The bone flap is typically stored or replaced with a synthetic implant once swelling subsides.

Minimally Invasive Endoscopic Surgery

For certain haematomas, neurosurgeons may use endoscopic techniques using a thin tube with a camera, which may be employed through smaller incisions. This can help reduce tissue disruption, particularly for deeper haemorrhages.

Technology & Equipment Used

Neurosurgical procedures may utilise neuronavigation systems, which are computer-guided tools for precise localisation, intraoperative monitoring to track brain function, and microscopic visualisation to assist surgical precision. Specialised instruments are used to minimise trauma to the surrounding tissue.

Following a brain injury, speak with our Senior Consultant Neurosurgeon to review your condition and explore appropriate management options.

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The Treatment Process

Pre-Treatment Preparation

Emergency cases require rapid stabilisation. This may involve securing the patient’s airway, managing blood pressure, and performing imaging such as CT or MRI scans to identify bleeding or damage. Blood tests are conducted to assess clotting function nd overall health. Medications may be administered to help reduce brain swelling and prevent seizures. Family members are kept informed and provided consent when patients cannot.

For planned surgeries, patients undergo a comprehensive neurological assessment and imaging studies, alongside optimisation of existing medical conditions. Pre-operative instructions include any necessary medication adjustments and fasting requirements.
During the Procedure

Patients are placed under general anaesthesia to ensure they are unconscious and pain-free during the surgery, with continuous monitoring of brain function. The surgical team positions the patient carefully to allow optimal access while protecting pressure points.
For craniotomy procedures, the bone flap is carefully removed and preserved. The neurosurgeon addresses the injury by draining blood collections, repairing damaged blood vessels, or removing bruised or damaged brain tissue. Bleeding is carefully managed to reduce the risk of further complications. Procedure duration depends on the complexity of the injury and the surgical approach.
Immediate Post-Treatment

After surgery, patients recover in the neurosurgical intensive care unit with continuous monitoring of neurological status, intracranial pressure, and vital signs. Post-operative imaging may be performed to assess the results of the surgery and to check for any complications. Pain management is provided to maintain patient comfort while allowing accurate neurological assessment. Some patients may initially remain intubated to support breathing, with gradual removal of the breathing tube as their condition stabilises.

Recovery & Aftercare

First 24-48 Hours

Close neurological monitoring continues with frequent assessments of consciousness, pupil reactions, and motor function. Intracranial pressure monitoring helps guide medical management. Healthcare providers manage pain with appropriate medications while maintaining alertness for neurological assessment. Family members receive regular updates on progress and can visit in accordance with ICU protocols.

Warning signs that may indicate immediate attention include:

Decreased level of consciousness
New or worsening weakness
Severe headache
Seizures

The medical team responds rapidly to any changes in neurological status.

First Week

Gradual mobilisation begins as tolerated. It starts with bed positioning and progresses to sitting and standing with assistance. Respiratory therapy helps prevent pneumonia through breathing exercises and secretion management. Nutritional support transitions from intravenous to oral feeding as swallowing function returns.

Daily neurological assessments track recovery progress. Healthcare providers adjust medications based on individual needs. Physiotherapy and occupational therapy begin with gentle exercises to maintain joint mobility and help prevent complications.

Long-term Recovery

Recovery timelines vary depending on the severity of the injury and individual factors. Patients may undergo rehabilitation programs focusing on physical, cognitive, and speech therapy. Regular follow-up appointments help monitor healing and detect any delayed complications.

For patients who underwent decompressive craniectomy, skull reconstruction surgery may be scheduled several months later to replace the bone that was temporarily removed. Medications to reduce the risk of seizures may continue as prescribed by the neurosurgical team. Recovery outcomes differ between patients, and some may experience lasting deficits requiring ongoing support and care.

If you or a loved one has experienced a brain injury, consult our Senior Consultant Neurosurgeon to review the trauma and discuss the next steps in management.

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Benefits

Brain trauma surgery involves procedures to manage injuries to the brain and surrounding structures. Key considerations include:

Evacuation of haematomas: removal of blood collections within the skull
Management of ongoing brain compression: addressing swelling or bleeding that affects brain tissue
Relief of elevated intracranial pressure: reducing pressure inside the skull
Addressing complications such as hydrocephalus
Decompression procedures: creating space to relieve pressure on the brain
Repair of structural injuries, including skull fractures and damaged brain tissue

Each procedure is tailored to the patient’s specific condition, injury type, and severity. Timing and surgical approach depend on the clinical situation.

Risks & Potential Complications

Common Side Effects

Temporary effects may occur following brain trauma surgery. These can include:

Headache after surgery, which may be managed with prescribed pain medication
Scalp swelling and bruising that may resolve over weeks
Temporary confusion or cognitive changes during recovery
General fatigue, which may require a gradual return to normal activities
Tenderness at the surgical site as healing takes place

These effects can vary between individuals and may resolve with appropriate supportive care.

Rare Complications

Less common but serious complications may include:

Post-operative haemorrhage that may require repeat surgery in some cases
Surgical site infection, which may require antibiotics or drainage
Cerebrospinal fluid leaks that may require repair
Seizures, which may occur after surgery and may require medical management
Stroke from vessel injury during the surgery
Hydrocephalus that may require shunt placement to drain excess fluid

Surgical risks are considered during pre-operative assessment, and patients are monitored closely after surgery for early detection of complications. Management is provided based on the patient’s clinical condition if complications arise.

Cost Considerations

The cost of brain trauma surgery in Singapore varies depending on several factors, including:

Complexity and duration of the surgical procedure required
Whether the surgery is performed on an emergency or planned basis
Length of Intensive Care Unit (ICU) and hospital stay
Use of surgical equipment and monitoring devices
Post-operative rehabilitation requirements• Need for repeat imaging studiessuch as CT or MRI•
Medications and nursing care

The total cost typically includes surgeon fees, anaesthesia services, operating theatre charges, hospitalisation, and immediate post-operative care. Additional services, such as rehabilitation therapy and follow-up appointments, may incur separate charges.

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Frequently Asked Questions

How quickly must brain trauma surgery be performed after injury?

The timing of brain trauma surgery depends on the type and severity of the injury. Life-threatening haematomas that cause significant pressure on the brain may require emergency surgery within hours. Epidural haematomas are generally treated as surgical emergencies and often require immediate intervention. Acute subdural haematomas with significant mass effect may also require urgent evacuation.

In some cases, such as certain brain contusions, close monitoring may be undertaken initially, with surgery considered if the condition worsens. Less severe injuries may be managed with medical treatment before surgical intervention is considered. The timing of surgery is determined after assessment of neurological status, imaging findings, and the patient’s overall medical condition.

What determines whether minimally invasive or open surgery is chosen?

The choice of surgical approach depends on several factors, including the location, size, and type of haematoma, as well as the severity of the brain swelling. Superficial or large haematomas may require craniotomy for complete evacuation and bleeding control.

Deep-seated haemorrhagesmight be managed with minimally invasive techniques. In cases of severe brain swelling that does not respond to medical treatment, a decompressive craniectomy may be considered to reduce pressure within the skull.

Other considerations include the presence of multiple injuries, wound contamination, and the patient’s overall medical condition. The surgical approach is selected based on individual clinical assessment and intraoperative considerations.

How long does recovery from brain trauma surgery take?

Recovery timelines vary between patients and depend on factors such as initial injury severity, patient age, and pre-existing health. Mild injuries might allow a return to normal activities within several months. Moderate injuries often require rehabilitation lasting several months up to a year. Severe injuries may need extended therapy over the years, with the extent of recovery differing for each individual. Initial ICU stays range from days to weeks, followed by inpatient rehabilitation for several weeks. Outpatient therapy may continue for months. Cognitive recovery often progresses more slowly than physical recovery. Progress can continue over an extended period following the injury.

Will I need additional surgeries after the initial brain trauma surgery?

Some patients may require staged procedures \depending on their condition. Decompressive craniectomy patients may need skull reconstruction once brain swelling resolves, which may occur several months later.

Hydrocephalus that develops weeks to months post-injury might require placement of a ventriculoperitoneal shunt. Complex skull fractures may need delayed repair after initial stabilisation. Some patients may develop chronic subdural haematomas that require evacuation months after initial injury. In rare cases, infection or wound complications necessitate revision surgery. Our neurosurgeon monitors for these possibilities during follow-up appointments.

What long-term effects should I expect after brain trauma surgery?

Long-term outcomes vary widely based on injury severity and affected brain regions. Many patients can achieve functional recovery with appropriate rehabilitation. Commonly seen persistent challenges may include:

Mild cognitive difficulties with memory or concentration
Occasional headaches managed with medication
Subtle personality changes observed by family members

Some experience persistent fatigue requiring lifestyle adjustments. Seizure risk may remain elevated, potentially requiring long-term anti-epileptic medication. Physical deficits, such as weakness or coordination problems, may improve gradually with therapy. Our neurosurgeon can support you in managing any persistent symptoms according to your individual recovery needs.

How can family members support recovery after brain trauma surgery?

Family involvement can play an important role in recovery. Brian’s trauma recovery can be emotionally challenging for both patients and families, but supportive care can help patients navigate this period.

During hospitalisation:

Maintain a calm, supportive presence
Participate in care team discussions when appropriate
Learn about the injury and recovery process from the medical team
Assist with orientation and memory exercises as advised by therapists

After discharge:

Adhere to prescribed medications and follow-up appointments
Create a structured and low-stress home environment to support

Adhere to prescribed medications and follow-up appointments
Create a structured and low-stress home environment to support recovery
Encourage engagement in prescribed therapies while respecting fatigue limits
Watch for concerning symptoms such as severe headaches, confusion, seizures, or vision changes that require medical attention

Joining caregiver support groups can provide additional guidance and encouragement. If you have concerns about recovery or observe any concerning symptoms, contact the clinic for guidance.

Conclusion

Brain trauma surgery addresses critical injuries to the brain and surrounding structures. While the neurosurgery may feel daunting, neurosurgeons use modern techniques and technology to manage injuries and monitor recovery. Comprehensive care is available, covering emergency intervention, post-operative management, and long-term rehabilitation. Understanding the surgical process, expected recovery, and importance of follow-up appointments allows patients and families to actively participate in the treatment journey and seek timely support when needed.

Ready to Take the Next Step?

If you or a loved one has experienced a brain injury, consult our Senior Consultant Neurosurgeon to review the condition and discuss the appropriate management steps.

Book Your Consultation Today

Dr Teo Kejia 张哿佳医生

Senior Consultant Neurosurgeon

MBBS (SG)●MRCS (Edin)●FAMS●FRCS Ed●IFAANS

Dr Teo Kejia is an experienced Senior Consultant Neurosurgeon and Director at Precision Neurosurgery.

Dr Teo has extensive knowledge and experience in the field of neurosurgery, with a particular focus on complex brain tumour procedures. He is adept in employing advanced surgical techniques, including brain mapping and awake brain surgery, especially for treating gliomas and glioblastomas. His expertise extends to neuro-oncology, encompassing both brain and spinal tumours, as well as neurovascular and skull base surgery.

Additionally, Dr Teo offers treatment for a range of neurological conditions, such as traumatic head injuries, intracerebral aneurysms, and degenerative spine disorders, which include neck and back pain. He is also proficient in managing ischemic and haemorrhagic strokes, hydrocephalus, trigeminal neuralgia, and hemifacial spasm.

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