Guest post from Kristopher T. Kimmell, MD
Neurosurgical Resident, University of Rochester Medical Center
By now many have grown numb to the statistics regarding traumatic brain injury (TBI) in the United States. Over two million people see a medical professional for symptoms related to a traumatic head injury each year. If these numbers only make the problem seem unreal, then consider the more personal side of traumatic head injury:
- A sixty-year-old woman slips down the stairs in her home, falling into a deep coma. She is found to have a large intracranial hemorrhage. Emergency surgery is performed, but it fails to improve her neurologic status.
- A ten-year-old boy is involved in a high-speed automobile accident on the freeway. His entire brain swells dangerously, threatening to progress to complete loss of blood flow to the brain, the result of which is brain death. He undergoes emergency surgery to have both sides of his skull removed and then is placed in a pharmacologic coma. After several weeks in the intensive care unit, followed by a prolonged stay in a rehabilitation hospital, he walks home with his mother and father and siblings.
- A twenty-four-year-old man, who had too much to drink while at a lake outing, crashes a jet ski into the dock. He comes into the hospital with a severe skull fracture that has lacerated the linings around his brain and has bruised the brain itself. He undergoes surgery to have the fractured bone fragments removed and goes home several days after his injury.
TBI is not a faceless public health issue that impacts people on the other side of the world. It is agnostic to your race, your gender, your age and your socioeconomic status. Its effects are felt on any number of people in your life: your neighbor, your child, your cousin, your grandmother. Despite its far-reaching effects, TBI is still a very poorly understood disease process. As General Peter Chiarelli cogently pointed out in his blog post, there is a lack of consensus regarding how to diagnose, how to treat, and how to assess treatments for TBI. It is hard to fight an enemy when you don’t even know what to call it.
Dr. Geoff Manley has set out to change that.
Geoffrey T. Manley, MD, PhD, FAANS, is Vice Chairman of Neurological Surgery at the University of California, San Francisco. He is Chief of Neurosurgery at San Francisco General Hospital and the Co-Director of the UCSF Brain and Spinal Injury Center (BASIC). He is also one of the principal investigators of a radical new National Institutes of Health–National Institute of Neurological Disorders and Stroke (NIH-NINDS) sponsored trial called TRACK-TBI. The goal of TRACK-TBI is to transform clinical research in TBI. It is the first precision medicine effort in TBI research, with a goal to collect clinical, blood/biospecimen, radiologic and outcome data from three thousand TBI patients nationwide. At present, the trial is over halfway to its goal, with over sixteen hundred patients enrolled. The data collected will be stored in an accessible data repository, with the goal not only to gain further insight into the TBI disease process, but also to help in designing future clinical trials. As Dr. Manley points out, the current understanding of TBI is “as an event, not a process.” Currently, there is no way even to confirm a diagnosis of TBI in many patients with milder injuries, such as concussion. But with data collected from studies such as TRACK-TBI, we may be even closer to a combination of blood test and imaging study that could confirm the diagnosis and, as a result, lead to new treatments. With newly tested and validated treatments there will be ways to track outcomes and improve the quality of care for patients with all levels of TB I— from mild concussion to more severe traumatic injuries.
Dr. Manley has always had a passion for neurosciences and neurosurgery. He obtained his MD and PhD in the Medical Scientist Training Program while at Cornell University in New York. During his neurosurgery training at UCSF, he immediately saw the opportunity to make a clinical impact by studying traumatic injuries of the brain and spinal cord. He is passionate not only about the science of TBI, but also the day-to-day care of patients with traumatic injuries. There are few surgeries a neurosurgeon can perform where the immediate result is saving a life; however, may neurotrauma cases, such as removing a large traumatic hemorrhage that is compressing the brain, offer the neurosurgeon such a gratifying opportunity. Dr. Manley believes that the field of neurotrauma is wide open to neurosurgeons, with so little known regarding a disease process that has such a significant public health impact. To date, many patients who sustain a TBI are an orphaned population, with no clinics or specialists available to help them deal with the aftermath and recovery from their injury. Dr. Manley asserts that neurosurgeons are best suited to be leaders in the field of TBI.
Editor’s Note: During the month of September, we encourage everyone to join the conversation online by using the hashtag #ConcussionFacts.