# Minimally Invasive and Proactive Approaches for Treatment of Acute Traumatic Brain Injury in Elderly Patients

## TL;DR

This paper discusses new, less invasive methods for treating traumatic brain injuries in elderly patients, focusing on biomarkers and surgical techniques to improve outcomes.

## Contribution

The paper introduces a minimally invasive surgical approach and highlights the use of D-dimer as a biomarker for early detection of brain injury in elderly patients.

## Key findings

- Blood D-dimer can detect brain damage with high sensitivity and specificity without needing a head CT.
- Mini-craniotomy with neuroendoscopic assistance reduces invasiveness, bleeding, and operation time compared to major craniotomy.
- Reversal therapy administered early can mitigate hematoma expansion in patients on antithrombotic drugs.

## Abstract

The elderly population in Japan was 29.3% in 2024, the highest in the world, making medical care for elderly patients an urgent social issue. There are challenges in providing care for elderly patients with head injury, since the buffering effect of the expansion of the subdural space due to brain atrophy masks the neurological symptoms caused by a hematoma, making detection difficult. However, brain damage can be detected with high sensitivity and specificity using blood D-dimer as a biomarker without the need for head computed tomography (CT). Also, about 30% of elderly patients with traumatic brain injury (TBI) are taking antithrombotic drugs, and the effects of these drugs on TBI may include an increase in intracranial hematomas and an increased risk of deterioration. Reversal therapy is used as a countermeasure to prevent hematoma expansion, but this requires the administration of a reversal agent early after injury and before hematoma expansion. In decompression surgery, the use of a mini-craniotomy with neuroendoscopic assistance under local anesthesia can reduce invasiveness, and this method significantly reduces intraoperative bleeding and operation times compared to a major craniotomy. These innovations have improved mortality for TBI in elderly patients, but there is still a need for improvements in functional outcomes.